Clinical Utility of Three-Dimensional CT in Acetabular Fractures: A Prospective Study of Fracture Classification, Surgical Approach Selection, and Reporting Efficiency

Abstract Background: Accurate characterization of acetabular fractures is essential for optimal surgical planning owing to the complex three-dimensional anatomy of the pelvis. Although multidetector computed tomography is the imaging modality of choice, the additional value of three-dimensional volume-rendered reconstructions over conventional two-dimensional multiplanar reformations remains an area of ongoing clinical interest. Purpose: To evaluate the role of three-dimensional computed tomography reconstructions in acetabular fracture classification, reporting efficiency, surgical planning, and postoperative radiological assessment. Materials and Methods: In this prospective analytical observational study, 52 adult patients with acetabular fractures underwent multidetector computed tomography using a Multislice scanner with two-dimensional multiplanar and three-dimensional volume-rendered reconstructions. Fractures were independently assessed using two-dimensional and three-dimensional datasets in alternating order. Classification was performed using three systems: Judet–Letournel, Orthopedic Trauma Association/ Arbeitsgemeinschaft fur Osteosynthesefragen, and Harris systems. Reporting time for each modality was recorded. Imaging-based surgical approach recommendations were correlated with the actual operative management, and postoperative reduction was graded using Matta’s radiographic criteria. Results: Anterior column fractures were the most common subtype (32.7%). Elementary fractures accounted for 73.1% of cases, while associated fractures comprised 26.9%. The mean interpretation time was significantly lower using three-dimensional reconstructions (35.58 ± 5.26 seconds) compared with two-dimensional images (65.42 ± 8.72 seconds), demonstrating a mean reduction of 29.08 seconds (p < 0.001). Imaging-guided surgical recommendations showed high concordance with the operative approach, with 88.2% agreement in anterior and posterior groups. Postoperative evaluation based on Matta’s criteria revealed anatomical reduction in 45.8%, satisfactory reduction in 45.8%, and poor reduction in 8.3% of cases. Conclusion: Three-dimensional computed tomography reconstructions significantly enhance reporting efficiency and improve fracture classification and preoperative planning in acetabular fractures. By providing superior spatial visualization of complex fracture patterns, three-dimensional imaging facilitates surgical decision-making and strengthens radiologist–surgeon communication, thereby contributing to optimized clinical outcomes.