Posterior pelvic ring fractures: Intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws

Ghisla, Simone; Napoli, Francesca; Lehoczky, G; Delcogliano, Marco; Habib, Nermine; Arigoni, Michele; Filardo, Giuseppe; Candrian, Christian

doi:10.1016/j.otsr.2018.07.006

Cited by 33 publications

(24 citation statements)

References 30 publications

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“…Using 3D fluoroscopic navigation when performing pelvic surgery is reported to be useful in planning screw position. The above disadvantages could be reduced with 2D-or 3Dfluoroscopic navigation, but the malposition rate of screw fixation for pelvic fractures ranges from 0% to 31%, demonstrating that there's still certain room to improve the technology [27][28][29] . Additionally, too much radiation exposure to patients and surgeons will also cause great harm to their bodies.…”

Section: Clinical and Radiological Results With Robot-aided Surgerymentioning

confidence: 99%

Robot‐Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation

Liu

Tian

et al. 2021

Orthopaedic Surgery

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Objective: To investigate the surgical strategy, safety, and efficacy of close reduction and robot-aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. Methods: Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot-aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow-up. Results: There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow-up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015). Conclusions: Robot-aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome.

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Section: Clinical and Radiological Results With Robot-aided Surgerymentioning

confidence: 99%

Robot‐Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation

Liu

Tian

et al. 2021

Orthopaedic Surgery

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“…A retrospective, single-center cohort study on 102 traumatic patients was reported by Pishnamaz et al [ 33 ]. Misplacement in conventional placed screws is reported to be between 8.8–12.4% [ 4 , 33 , 34 ] in conventionally techniques and 3.6–4.9 % using 3D navigation [ 4 , 35 ]. We found correct screw placement in 91.23%, whereas minor screw displacement (<3.6 mm) occurred in 4.5% and major displacement was seen in 3.08%.…”

Section: Discussionmentioning

confidence: 99%

“…Most reports on screw misplacement and safety report on traumatic pelvic fractures [ 2 , 4 , 33 , 34 , 35 , 36 ]. The present study does not differentiate between traumatic and fragility fractures in this specific context.…”

Section: Discussionmentioning

confidence: 99%

Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

Hartensuer

Lodde

Keller

et al. 2020

JCM

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Background: Minimally invasive sacroiliac-screw (SI-screw) fixation of the pelvis is used in energy trauma (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classified) and fragility fractures (Fragility Fracture of the Pelvis (FFP) classified). However, available clinical data are based on small case series and biomechanical data seem to be contradictory. Methods: The present single center retrospective cohort study investigated percutaneous SI-screw fixation and augmentation over 15 years. Groups were compared concerning the general epidemiological data, mobilization, complication rates, duration of stay, and safety of SI-screw insertion. Multivariable analyses were performed using logistic regression. Results: Between 2005 and March 2020, 448 patients with 642 inserted SI-screws were identified. Iatrogenic neurological impairment was documented in 2.47% and correlated with screw misplacement. There was an increased complication risk in patients with AO type C over patients with AO type B and in FFP II over FFP III/IV patients. Cement-augmented FFP patients showed a 25% reduced stay in hospital and a reduced complication risk. Cement-associated complications were seen in 22% without correlation to neurologic impairment. Conclusions: The present study confirms the safety and usability of percutaneous SI-screw fixation, despite specific risks. Cement augmentation seems to reduce the complication risk in FFP patients and shorten hospital stay for some reasons, without increased specific complications or correlated neurological impairment.

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“…Also, the time required to place each screw and the radiation exposure times in the guide apparatus group was significantly better than in the free-hand group, and no complications were noted at the final follow-up. Although much time was spent in finding the exiting point, the duration of the operation and the number of fluoroscopy exposures were significantly reduced, and there are no expensive surgical instruments required because the manufacture of the guide apparatus is simpler and cheaper than a robot, CT machine, or 3D navigation [24]. Ultimately, surgeons who are adept at inserting iliosacral and transiliac-transsacral screws can master this technique with a small learning curve.…”

Section: Discussionmentioning

confidence: 99%

A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

Zheng

Luo

et al. 2021

J Orthop Surg Res

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Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

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Posterior pelvic ring fractures: Intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws

Abstract: IV, Retrospective study.

Cited by 33 publications

References 30 publications

Robot‐Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation

Robot‐Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation

Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

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