Teaching Letournel classification: systematic analysis of x-rays using algorithm versus 3D computed tomography scan

Background The aim of Letournel classification was to identify accurately the pathological anatomy of the fractured acetabulum. For orthopedic residents, this classification system is somewhat cumbersome. An important objective is to facilitate the understanding of this classification system among the junior residents. The aim of this study was to compare two educational tools, namely the systematic analysis of the plain films and the 3D computed tomography (CT) scans in improving the diagnostic performance of orthopedic residents. Patients and methods Twenty x-rays set for acetabular fractures, including A/P, iliac, and obturator view, were selected from our hospital database. These sets were prepared in a quiz form. Thirty residents were asked to diagnose the given fracture using x-rays only. Then, the residents were randomly allocated to two groups. Group I was asked to repeat the same quiz with the addition of 3D CT-reformatted images (A/P and obliques). Group II was asked to analyze the same x-rays using an algorithm. Data collected included the training period of the resident, the answers in pre- and post-tests together with the subjective assessment of how difficult each diagnosis was. Results While the two groups showed a significant and similar improvement in reaching the right diagnosis, using the algorithm was significantly easier. Conclusion Compared with the advanced imaging technology, plain x-ray film if analyzed systemically is an easier way to understand Letournel classification when educating junior orthopedic residents.