Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: The interest of O-ARM CT-guided navigation

Abstract

The precision and safety of iliosacral screw fixation are now unequalled, meeting the basic computer-assisted surgery principles of reduced morbidity without overexposure to ionizing radiation. Indications for computer-assisted surgery should therefore be extended to iliosacral pathologies (arthritic, tumoral and inflammatory), non-displaced acetabular fracture, etc.

Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture

“…Acetabular defects were treated with autograft and/or allograft bone chips with a cemented all-polyethylene cup. At a follow-up of 9.5 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], the mean HHS was 93 points (range, 62-100 points) in the 16 surviving patients, 14 who were pain free. Zhang et al [28] assessed the ability to restore hip center using an acetabular reinforcement ring and a cemented cup in patients treated with prior open reduction internal fixation (n = 49 hips).…”

“…In 34 hips in 33 patients who had a mean age of 49.8 years (range, 19-78), there were nine acetabular revisions at mean follow-up of approximately 12 years (range, [10][11][12][13][14][15][16]. Of the 26 acetabular components with a minimum 10 years follow-up, only two were loose.…”

“…The use of bone grafting with cementation has also shown good implant survivorship. Schreurs et al [34] (n = 20 patients) had only two patients revised at a follow-up of 9.5 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. One was revised for septic loosening and the other for aseptic loosening at 14.5 years and 15.3 years, respectively.…”

“…Therefore, many surgeons currently treat these injuries surgically depending on the magnitude of displacement and fracture pattern with various strategies, including percutaneous fixation [12][13][14], open reduction internal fixation [15,16] or hip arthroplasty [17,18]. Even when operative treatment goals are achieved, arthritis can develop in up to 30% of patients [1,2,7,19,20].…”

Percutaneous Fixation by Internal Cemented Screw for the Treatment of Unstable Osseous Disease in Cancer Patients

“…These considerations have prompted surgical interest in imaging navigation technologies to assist in screw placement. [14][15][16] A recent paradigm shift applies interventional radiology techniques to enable highly accurate and minimally invasive osseous fixation. Percutaneous fixation by internal cemented screw (FICS) describes the percutaneous advancement of cannulated screws across a fracture line or unstable osseous metastasis, with additional cement consolidation.…”