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Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures

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Abstract

Introduction

The objective of this study is to report the institutions experiences with standardized 2D computer-navigated percutaneous iliosacral screw placement (CNS), as well as the conventional fluoroscopically assisted screw placement method (CF) over a period of 10 years.

Patients and methods

A total of 604 patients with sacral fractures (OTA B and C) were treated at the institution. Cases with both, a preoperative and postoperative CT scan were included for further analysis. With this prerequisite, a total of 136 cases were included. The quality of screw positioning, length of operation and intraoperative radiation exposure were recorded and compared. Moreover, it was analyzed whether the presence of dysmorphic sacra influenced the precision of screw positioning.

Results

Two hundred and thirty-two screws were implanted in 136 patients (100 navigated, 36 conventional). The duration of the average procedure was similar in the two groups [49.8 min (p = 0.7) conventional group (CF) vs. 48.0 min computer-navigated (CNS) group]. With computer navigation, radiation exposure was significantly reduced by almost half [128.3 vs. 65.2 s (p = 0.023)]. Screw placement was more accurate in the navigation group (79.03% CF vs. 86.47% CNS). The presence of dysmorphic sacral foramina or an increased alar slope increased the incidence of screw malpositioning.

Conclusion

The conventional percutaneous method and a standardized 2D navigated method have similar rates of malpositioning. Dysmorphic upper sacral foramina and increased alar slope were identified as risk factors for screw malpositioning. Radiation exposure rates were reduced by half when using computer navigation. Therefore, computer navigation in iliosacral screw placement is recommended as method of choice.

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Author notes

  1. Maximilian J. Hartel and Lars G. Grossterlinden contributed equally and therefore share last authorship.

Authors and Affiliations

  1. Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Josephine Berger-Groch, Marie Lueers, Johannes Maria Rueger, Darius Thiesen, Jan Philipp Kolb & Maximilian Johannes Hartel

  2. Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen Medical School, Göttingen, Germany

    Wolfgang Lehmann

  3. Department of Orthopaedics, Trauma- and Spine Surgery, Asklepios Hospital Hamburg-Altona, Hamburg, Germany

    Lars Gerhard Grossterlinden

Authors
  1. Josephine Berger-Groch
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  2. Marie Lueers
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  4. Wolfgang Lehmann
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  7. Maximilian Johannes Hartel
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  8. Lars Gerhard Grossterlinden
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Contributions

JBG, MJH and LGG developed the study design. JBG, ML, DT performed the literature research. JBG, ML, MJH and LGG collected the data and interpreted the data. JBG, MJH, LGG and DT wrote the paper. JMR and WL were responsible for critical revision.

Corresponding author

Correspondence to Maximilian Johannes Hartel.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this study was retrospective, formal consent was not required.

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Berger-Groch, J., Lueers, M., Rueger, J.M. et al. Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures. Eur J Trauma Emerg Surg 46, 107–113 (2020). https://doi.org/10.1007/s00068-018-0990-z

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  • DOI: https://doi.org/10.1007/s00068-018-0990-z

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