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Archives of Orthopaedic and Trauma Surgery

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01-02-2019 | Trauma Surgery

Factors influencing the accuracy of iliosacral screw insertion using 3D fluoroscopic navigation

Authors: Masaki Takao, Hidetoshi Hamada, Takashi Sakai, Nobuhiko Sugano

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2019

Abstract

Introduction

The purpose of the present study was to determine which factors affect the positional accuracy of iliosacral screws inserted using 3D fluoroscopic navigation. Specifically, we asked: (1) does the screw insertion angle in the coronal and axial planes affect the positional accuracy of iliosacral screw insertion using 3D fluoroscopic navigation? (2) Is the positional accuracy of iliosacral screw insertion using 3D fluoroscopic navigation affected by the type of screw (transsacral versus standard iliosacral), site of screw insertion (S1 versus S2), patient position (supine versus prone), presence of a dysmorphic sacrum, or AO/OTA classification (type B versus C)?

Materials and methods

Twenty-seven patients with AO/OTA type B or C pelvic ring fracture were treated by percutaneous iliosacral screw fixation. A total of 55 screws were inserted into S1 or S2 using 3D fluoroscopic navigation combined with preoperative CT-based planning. The positional accuracy of screw placement was assessed by matching postoperative CT images with preoperative CT images. The distance between the central axis of the inserted screw and that of the planned screw placement was measured in the sagittal plane passing through the center of the vertebral body.

Results

The mean deviation between the planned and the inserted screw position was 2.9 ± 1.7 mm (range 0–8.5 mm) at the vertebral body center. Multiple regression analysis showed that the screw insertion angle relative to the vertical line of the bone surface in the axial plane (β = 0.354, p = 0.013) and the use of a transsacral screw (β = 0.317, p = 0.017) were correlated with the positional accuracy of screw placement (adjusted R² = 0.276, p = 0.002).

Conclusions

A greater screw insertion angle relative to the vertical line on the bone surface and the use of transsacral screws increases the positional error of iliosacral screws inserted using 3D fluoroscopic navigation.

Level of evidence

Level IV, therapeutic study.

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Title: Factors influencing the accuracy of iliosacral screw insertion using 3D fluoroscopic navigation
Authors: Masaki Takao
Hidetoshi Hamada
Takashi Sakai
Nobuhiko Sugano
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3055-1

At a glance: The STEP trials

Springer Medicine

Factors influencing the accuracy of iliosacral screw insertion using 3D fluoroscopic navigation

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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