Posterior pelvic ring fractures: Intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws - 29/10/18
, Gyozo Lehoczky b, Marco Delcogliano a, Nermine Habib a, Michele Arigoni c, Giuseppe Filardo d, Christian Candrian a
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Abstract |
Introduction |
Posterior pelvic ring fractures frequently pose a problem of stability with an elevated risk of complications. The traditional method of percutaneous sacroiliac (SI) stabilization with the use of fluoroscopic image amplifiers demands a high degree of experience and has an elevated risk of screws’ malpositioning.
Hypothesis |
Intraoperative 3D-CT scan coupled with a navigation system (O-Arm©) can allow screw fixation accuracy while limiting the risk of complications for the treatment of posterior pelvic ring fractures.
Material and methods |
Patients with posterior pelvic ring fractures stabilized with percutaneous SI screws through O-Arm© navigation from August 2008 to December 2017 were analyzed. A modified Gras classification was used to determine screws’ positioning under CT visualization, and intraoperative and early postoperative complications were documented.
Results |
Among the 21 patients evaluated, 14 men and 7 women with a mean age of 57.8 years (range 25–91), receiving 39 screws, the rate of misplacement was low: 82% grade I, 15.4% grade II, and only 2.6% grade III. Only one patient underwent revision surgery, not because of misplacement but rather for a secondary implant loosening. No complications occurred in this series.
Discussion |
This study documented a large series of patients treated for pelvic ring fractures using the intraoperative 3D-CT O-Arm© guided navigation. This surgical approach provided a precise and safe SI screw positioning with no complications.
Level of evidence |
IV, Retrospective study.
Le texte complet de cet article est disponible en PDF.Keywords : Posterior pelvic ring fracture, Sacro-liac screws fixation, O-Arm©
Plan
Vol 104 - N° 7
P. 1063-1067 - novembre 2018 Retour au numéro
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