PMC8494600_01
Preoperative CT-scan of a 71-year-old woman on admission.
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In her previous history, the patient received wide laminectomy and interbody fusion with PEEK cage for spondylolisthesis and spinal stenosis, without additional pedicle screw fixation, in another institution two years ago (Figures 1 and 2).
Preoperative anteroposterior roentgenogram of the patient. The arrow shows a previously inserted intervertebral PEEK cage.
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In her previous history, the patient received wide laminectomy and interbody fusion with PEEK cage for spondylolisthesis and spinal stenosis, without additional pedicle screw fixation, in another institution two years ago (Figures 1 and 2).
Preoperative lateral roentgenogram at one-year follow-up. L3 to lumbopelvic fixation.
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In the revision surgery, two iliac screws 85 and 75 mm long and 8 mm thick were inserted under fluoroscopy from the posterior superior iliac spine obliquely downwards to the ipsilateral acetabulum roof, respectively (Figures 3 and 4).
Postoperative anteroposterior roentgenogram of the lumbar spine.
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In the revision surgery, two iliac screws 85 and 75 mm long and 8 mm thick were inserted under fluoroscopy from the posterior superior iliac spine obliquely downwards to the ipsilateral acetabulum roof, respectively (Figures 3 and 4).
Lateral roentgenogram 18 months postoperatively showing a vertebral compression fracture of the L1 vertebra (arrow).
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The roentgenographic examination disclosed a hemitransverse Letournel-type acetabular fracture in the right hip (Figures 5-8) and a severe compression fracture of the 12th thoracic and 2nd lumbar-vertebra.
Anteroposterior roentgenogram of the right hemipelvis 18 months postoperatively showing a transverse-type Letournel fracture of the right acetabulum (big arrow). Small arrows show the radiolucent area around the tip of the right iliac screw. There is radiolucency around the iliac screw.
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The roentgenographic examination disclosed a hemitransverse Letournel-type acetabular fracture in the right hip (Figures 5-8) and a severe compression fracture of the 12th thoracic and 2nd lumbar-vertebra.
Right oblique Judet roentgenogram 18 months postoperatively showing the transverse fracture of the right acetabulum (long arrow) with disruption of the posterior acetabular column and the tip of the iliac screw (short arrow).
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The roentgenographic examination disclosed a hemitransverse Letournel-type acetabular fracture in the right hip (Figures 5-8) and a severe compression fracture of the 12th thoracic and 2nd lumbar-vertebra. There was a continuous wide radiolucent line around the tip of the right iliac screw (Figures 7 and 8).
Oblique left Judet roentgenogram of the right hip 18 months postoperatively showing the transverse acetabular fracture. The left hemipelvis and particularly the acetabulum are intact. There is a radiolucent line around the tip of the left iliac screw. The right iliac screw has a central correct between the anterior and posterior iliac cortices.
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The roentgenographic examination disclosed a hemitransverse Letournel-type acetabular fracture in the right hip (Figures 5-8) and a severe compression fracture of the 12th thoracic and 2nd lumbar-vertebra. There was a continuous wide radiolucent line around the tip of the right iliac screw (Figures 7 and 8).
CT reconstruction image showing the transverse fracture line in the right hip. Note the proximity of the right iliac screw to the acetabular roof. Correct position of the iliac screws within the laminae of the pelvic bone bilaterally.
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The pelvis CT-scan showed a pseudarthrosis in the right acetabulum close to the right iliac screw tip (Figures 9 and 10).
Frontal CT reconstruction image of the pelvis.
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The pelvis CT-scan showed a pseudarthrosis in the right acetabulum close to the right iliac screw tip (Figures 9 and 10).
Anteroposterior pelvis roentgenogram showing the acetabular fracture (right, thick arrow) and radiolucent line around the left iliac screw (small arrow).
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The relatives made in her local radiologist new AP plain pelvis roentgenogram (Figure 11) that showed atrophic pseudarthrosis and radiolucencies around the iliac screws and CT-scans (Figures 12 and 13), and the patients' relatives sent it to us.
Axial CT-scan view showing the acetabular nonunion on the right.
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The relatives made in her local radiologist new AP plain pelvis roentgenogram (Figure 11) that showed atrophic pseudarthrosis and radiolucencies around the iliac screws and CT-scans (Figures 12 and 13), and the patients' relatives sent it to us. There was now an evident atrophic pseudarthrosis in the site of the transverse acetabular fracture (Figures 12 and 13, arrow).
Sagittal right pelvis reconstruction CT-image showing the acetabular pseudarthrosis line (arrow).
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The relatives made in her local radiologist new AP plain pelvis roentgenogram (Figure 11) that showed atrophic pseudarthrosis and radiolucencies around the iliac screws and CT-scans (Figures 12 and 13), and the patients' relatives sent it to us. There was now an evident atrophic pseudarthrosis in the site of the transverse acetabular fracture (Figures 12 and 13, arrow).