3D - Navigated percutaneous screw fixation of pelvic ring injuries – a pilot study

Introduction: Screw fixation of pelvic ring fractures is a common, but demanding procedure and navigation techniques were introduced to increase the precision of screw placement. The purpose of this case series is to demonstrate a lower screw malposition rate using percutaneous fixation of pelvic ring fractures and sacroiliac dislocations guided by navigation system based on 3D-fluoroscopic images compared to traditional imaging techniques and to evaluate the functional outcomes of this innovative procedure. Patient and Methods: 10 cases of disrupted pelvic ring lesions treated in our hospital from February 2018 to December 2018 were included for closed reduction and percutaneous screw fixation of using with O-Arm and the acquisition by the Navigator. Preoperative assessment was performed on the patients by means of X Ray imaging and CT scan. Routine CT was carried out on third postoperative day to evaluate screw placement. Measures of radiation exposure were extracted directly from reports provided by system. Quality of life was evaluated by SF 36-questionnaire 6 months after surgery. Results: 12 iliosacral- and 2 ramus pubic-screws were inserted. In post-operative CT-scans the screw position was assessed and graded using the score described by Smith. No wound infection or iatrogenic neurovascular damage were observed. No re-operations were performed. The exposure to radiation is, for the patient, slightly greater than that resulting from the use of traditional fluoroscopic systems, while it is naught for the surgical team, which at the time of image acquisition is located outside the room. Discussion and Conclusion: The execution of an intraoperative 3D-fluoroscopic scan can on its own suffice as a post-operative control examination since its accuracy is similar to that of the post-operative CT. The use of a navigated 3d fluoroscopy exposes the patient to an amount of radiation slightly greater than that of traditional fluoroscopy, but the dose is lower than a CT examination. For the operating team, exposure to radiation is naught. 3D-fluoroscopic navigation is a safe tool providing high accuracy of percutaneous screw placement for pelvic ring fractures. Finally, despite the small cohort of patients studied, the excellent results obtained regarding the patients' quality of life and the absence of complications allow us to look positively at the future of this technique, which needs further studies and improvement.