The hybrid operating room (H-OR) was designed to close the gap between multiple specialties, prevent impediments, and facilitate efficient care (1). The room features bi-plane flat plate robotic C-arms with large volume 3-dimensional fluoroscopic (3DF) capability. The imaging devices are digitally linked to a floor-based robotic table, and can be connected to navigation. While services such as neurosurgery, vascular surgery, and interventional radiology have led the way in developing advanced procedures specific to the hybrid suite, particularly those involving angiography, the superior image quality, large volume 3DF scanner, and the angiographic capabilities makes the H-OR appealing for pelvic and acetabular surgery.

It is critical that the surgeon be able to accurately assess the quality of repair in pelvic and acetabular fracture surgery (2). For this reason, some have advocated for post-operative computed tomography (CT) scans to evaluate reduction quality, hardware safety, and presence of intra-articular loose bodies, in order to perform any early revisions that may be necessary to improve outcome (3). The H-OR produces 2-dimensional (2D) image quality with a resolution that is four times greater than standard high definition fluoroscopy without significant increase in radiation exposure to the surgeon and operating room staff. [1, 2] The collimation feature allows excellent image contrast and definition, particularly in obese and markedly osteopenic patients. These advances improve the surgeon's accuracy in evaluating the intraoperative 2D imaging. In addition, the high volume 3DF is able to obtain rapid intra-operative, multiplanar CT like images. [3], [4], [5], [6] The 3DF technology allows for improved assessment of the reduction quality and hardware position while the patient is still under anesthesia, potentially obviating the need for a post operative CT scan. The surgeon is then able to make necessary corrections before the patient leaves the operating room, avoiding risk of subsequent revision corrective surgery and any associated increased cost or complication. [7, 8] By improving the surgeon's ability to evaluate the repair intraoperatively, the imaging available in the H-OR has the potential to improve patient outcomes.

The imaging capabilities in the hybrid suite also makes the room well suited for angiographic procedures, such as angioembolism and temporary arterial balloon occlusion (TABO). TABO, also known as an ‘‘internal tourniquet’’, has been described as an effective technique to decrease blood loss in various orthopaedic and non-orthopaedic surgical procedures. [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24] To date three studies have demonstrated a decrease in blood loss with the use of intra-arterial balloon occlusion for acetabular open reduction internal fixation (ORIF), however the hybrid suite was not utilized in either study. [13, 17, 20]

There is sparse literature regarding the application and use of the hybrid suite in orthopaedic trauma. We report our experience with the use of the H-OR for pelvic and acetabular fracture surgery with regard to the enhanced imaging technology and intra-arterial balloon occlusion.