Differences in Accuracy and Radiation Dose in Placement of Iliosacral Screws: Comparison between 3D and 2D Fluoroscopy

Kułakowski, Michał; Reichert, Paweł; Elster, Karol; Witkowski, Jarosław; Ślęczka, Paweł; Morasiewicz, Piotr; Oleksy, Łukasz; Królikowska, Aleksandra

doi:10.3390/jcm11061466

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…[22][23][24][25][26] However, the superiority of advanced imaging techniques over simple fluoroscopy with regard to the risks of neurovascular injury and implant malposition has not been clearly established. [22][23][24][25]27 The majority of pelvic fracture surgeons continue to use simple fluoroscopy, the most affordable and available imaging modality, for percutaneous pelvis fixation. 26,[28][29][30] Patient factors influence the quality and feasibility of fluoroscopic imaging in pelvis surgery.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views

Patterson,

Brown,

Hasegawa

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To estimate the prevalence of suboptimal fluoroscopy of sacral outlet images due to anatomic and equipment dimensions. Pelvic retroversion is hypothesized to mitigate this issue. Design: In silico simulations using retrospectively collected computed tomography (CT) data from human patients. Setting: Level I trauma center. Patient Selection Criteria: Adults with AO/OTA 61 pelvic ring disruptions treated with posterior pelvic fixation between July and December 2021. Outcome Measures and Comparisons : C-arm tilt angles required to obtain three optimal fluoroscopic sacral outlet images, defined as vectors from pubic symphysis to S2 and parallel to the first and second sacral neural foramina, were calculated from sagittal CT images. A suboptimal view was defined as collision of the C-arm radiation source or image intensifier with the patient/operating table at the required tilt angle simulated using the dimensions of five commercial C-arm models and trigonometric calculations. Incidence of suboptimal outlet views and pelvic retroversion necessary to obtain optimal views without collision, which may be obtained by placement of a sacral bump, was determined for each view for all patients and C-arm models. RESULTS: CT data from 72 adults were used. Collision between patient and C-arm would occur at the optimal tilt angle for 17% of simulations and at least one view in 68% of patients. Greater BMI was associated with greater odds of suboptimal imaging (standard outlet: OR 0.84, CI 0.79-0.89, p<0.001; S1: OR 0.91, CI 0.87-0.97, p=0.002; S2: OR 0.85, CI 0.80-0.91, p<0.001). S1 anterior sacral slope was associated with suboptimal S1 outlet views (OR 1.12, Cl 1.07-1.17, p<0.001). S2 anterior sacral slope was associated with suboptimal standard outlet (OR 1.07, Cl 1.02-1.13, p=0.004) and S2 outlet (OR 1.16, Cl 1.09-1.23, p<0.001) views. Retroversion of the pelvis 15-20° made optimal outlet views possible without collision in 95%-99% of all simulations, respectively. CONCLUSIONS: Suboptimal outlet imaging of the sacrum is associated with greater BMI and sacral slope at S1 and S2. Retroversion of the pelvis by 15-20° with a bump under the distal sacrum may offer a low-tech solution to ensure optimal fluoroscopic imaging for percutaneous fixation of the posterior pelvic ring. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views

Patterson,

Brown,

Hasegawa

et al. 2024

Journal of Orthopaedic Trauma

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“…For several decades, numerous researchers have depended on high-quality imaging apparatus, including computer navigation, O-arm navigation, and surgical robotics, in order to acquire precise intraoperative images [22][23][24]. This has resulted in enhanced screw insertion safety and accuracy[8].…”

Section: Discussionmentioning

confidence: 99%

An investigation to the clinical application of personalized 3D printed guides combined with preoperative virtual iliosacral screws for the management of posterior pelvic ring injury

Zhao,

Liu,

Chen

et al. 2024

Preprint

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Purpose Percutaneous iliosacral screws are difficult to utilise to treat pelvic ring instability injuries, and they usually require navigational or fluoroscopic guidance. The goal of this study is to create a unique 3D-printed guide for iliosacral screw insertion during surgery and evaluate its effectiveness and safety. Methods The same group of surgeons did a retrospective examination of patients who received surgery for an unstable posterior pelvic ring injury at our hospital's trauma centre between January 2020 and May 2023, in accordance with the selection criteria. Patients were categorised into two groups: the conventional surgery (CS) group (n = 17) and the 3D guide plate (GP) group (n = 14), based on the surgical techniques employed, the following variables were documented: Gender, age, cause of injury, sacral dysmorphism, fracture classification, screw insertion time, radiation exposure time for each screw, postoperative screw position grading, follow-up period, and fracture reduction quality. Results The CS group consisted of 17 patients, nine female and eight male, with an average age of 42.6 ± 13.4 years. A total of 14 patients presented with the GP group, consisting of eight females and six males, with an average age of 40.4 ± 13.1. The two groups had no statistically significant differences in sacral dysmorphism, follow-up time, fracture reduction quality, gender, age, cause of injury, or AO fracture classification (p > 0.05). A total of 42 iliosacral screws were inserted in 31 patients: 24 screws in the CS group (18 S1 and 6 S2), and 18 screws in the GP group (14 S1 and 4 S2). In comparison to the CS group, the GP group had substantially lower rates of screw misposition, radiation exposure time per screw, and insertion time per screw (5.56% versus 25.00%; 0.31 ± 0.14min versus 0.91 ± 0.17min; 17.29 ± 1.90min versus 25.18 ± 3.99min). Comparisons between the two groups regarding the duration of radiation exposure for each screw, and the time required to insert each screw were all statistically significant (p < 0.05), however, there was no significant difference in the rate of screw misposition between the two groups (P > 0.05). Conclusion In combination with 3D guide plate technology, the preoperative virtual screw can precisely position the iliosacral screw, thereby introducing a novel technique for percutaneous iliosacral screw placement.

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“…To reduce the occurrence of iatrogenic injury, many methods have recently been introduced to assist the insertion of sacroiliac screws. Using 3D-based fluoroscopy for the navigation of sacroiliac screws is not advantageous, compared with traditional 2D fluoroscopy 20 . Robot-assisted techniques, such as TiRobot and Artis Zeego, can effectively reduce the operation time and fluoroscopy times, and ensure the safety of the operation, helping the surgeon to quickly master sacroiliac screws surgery 21 , 22 .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative CT-assisted sacroiliac screws fixation for the treatment of posterior pelvic ring injury: a comparative study with conventional intraoperative imaging

Yang

Sheng

Liu

et al. 2022

Sci Rep

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Pelvic injuries refer to the disruption of the inherent structural and mechanical integrity of the pelvic ring. Sacroiliac screw fixation technique is often applied for the treatment of posterior pelvic ring injury, which is prone to the iatrogenic injury. This study will compare the intraoperative and postoperative variables of patients underwent sacroiliac screw fixation with intraoperative CT and conventional imaging to evaluate the effect. Thirty-two patients with posterior pelvic ring injury treated by sacroiliac screw fixation from January 2019 to December 2020 were enrolled in this retrospective study. All patients were divided into two groups according to the different assistance of intraoperative imaging. Subsequently, the correlative data were compared and analysed statistically. Twelves cases were assigned to intraoperative CT group, and the remaining twenty cases were assigned to conventional group. There was no significant difference in duration of surgery, fracture healing time, time to ambulation, complications, and Matta radiological score. There was statistically significant difference (p < 0.05) in sacroiliac screws insertion time, length of incision, intraoperative blood loss, quality of screws position, and adjusted Majeed functional score, especially in the sexual intercourse part. With the assistance of intraoperative CT, a less misposition and functional impairment could be achieved, and a more satisfactory curative effect could be developed. Sacroiliac screws fixation with intraoperative CT is a more accurate and ideal method to treat posterior pelvic ring injuries.

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Differences in Accuracy and Radiation Dose in Placement of Iliosacral Screws: Comparison between 3D and 2D Fluoroscopy

Cited by 6 publications

References 29 publications

Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views

Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views

An investigation to the clinical application of personalized 3D printed guides combined with preoperative virtual iliosacral screws for the management of posterior pelvic ring injury

Intraoperative CT-assisted sacroiliac screws fixation for the treatment of posterior pelvic ring injury: a comparative study with conventional intraoperative imaging

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