Top

European Journal of Trauma and Emergency Surgery

Published in:

01-02-2020 | Original Article

Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures

Authors: Josephine Berger-Groch, Marie Lueers, Johannes Maria Rueger, Wolfgang Lehmann, Darius Thiesen, Jan Philipp Kolb, Maximilian Johannes Hartel, Lars Gerhard Grossterlinden

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2020

Abstract

Introduction

The objective of this study is to report the institutions experiences with standardized 2D computer-navigated percutaneous iliosacral screw placement (CNS), as well as the conventional fluoroscopically assisted screw placement method (CF) over a period of 10 years.

Patients and methods

A total of 604 patients with sacral fractures (OTA B and C) were treated at the institution. Cases with both, a preoperative and postoperative CT scan were included for further analysis. With this prerequisite, a total of 136 cases were included. The quality of screw positioning, length of operation and intraoperative radiation exposure were recorded and compared. Moreover, it was analyzed whether the presence of dysmorphic sacra influenced the precision of screw positioning.

Results

Two hundred and thirty-two screws were implanted in 136 patients (100 navigated, 36 conventional). The duration of the average procedure was similar in the two groups [49.8 min (p = 0.7) conventional group (CF) vs. 48.0 min computer-navigated (CNS) group]. With computer navigation, radiation exposure was significantly reduced by almost half [128.3 vs. 65.2 s (p = 0.023)]. Screw placement was more accurate in the navigation group (79.03% CF vs. 86.47% CNS). The presence of dysmorphic sacral foramina or an increased alar slope increased the incidence of screw malpositioning.

Conclusion

The conventional percutaneous method and a standardized 2D navigated method have similar rates of malpositioning. Dysmorphic upper sacral foramina and increased alar slope were identified as risk factors for screw malpositioning. Radiation exposure rates were reduced by half when using computer navigation. Therefore, computer navigation in iliosacral screw placement is recommended as method of choice.

Buller LT, Best MJ, Quinnan SM. A nationwide analysis of pelvic ring fractures: incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil. 2016;7:9–17. https://doi.org/10.1177/2151458515616250.CrossRefPubMedPubMedCentral

Richter PH, Gebhard F, Dehner C, Scola A. Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room. Injury. 2016;47:402–7. https://doi.org/10.1016/j.injury.2015.11.023.CrossRefPubMed

Bastian JD, Jost J, Cullmann JL, et al. Percutaneous screw fixation of the iliosacral joint: optimal screw pathways are frequently not completely intraosseous. Injury. 2015;46:2003–9. https://doi.org/10.1016/j.injury.2015.06.044.CrossRefPubMed

Hopf JC, Krieglstein CF, Müller LP, Koslowsky TC. Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients. Injury. 2015;46:1631–6. https://doi.org/10.1016/j.injury.2015.04.036.CrossRefPubMed

Lindsay A, Tornetta P, Diwan A, Templeman D. Is closed reduction and percutaneous fixation of unstable posterior ring injuries as accurate as open reduction and internal fixation? J Orthop Trauma. 2016;30:29–33. https://doi.org/10.1097/BOT.0000000000000418.CrossRefPubMed

Radetzki F, Wohlrab D, Goehre F, et al. Anatomical conditions of the posterior pelvic ring regarding bisegmental transverse sacroiliac screw fixation: a 3D morphometric study of 125 pelvic CT datasets. Arch Orthop Trauma Surg. 2014;134:1115–20. https://doi.org/10.1007/s00402-014-2022-8.CrossRefPubMed

Routt ML, Simonian PT, Agnew SG, Mann FA. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996;10:171–7.CrossRef

Routt ML, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11:584–9.CrossRef

Theologis AA, Burch S, Pekmezci M. Placement of iliosacral screws using 3D image-guided (O-arm) technology and stealth navigation: comparison with traditional fluoroscopy. Bone Jt J. 2016;98–B:696–702. https://doi.org/10.1302/0301-620X.98B5.36287.CrossRef

10.

Zwingmann J, Hauschild O, Bode G, et al. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2013;133:1257–65. https://doi.org/10.1007/s00402-013-1788-4.CrossRefPubMed

11.

Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21:1–133.CrossRef

12.

Matta JM, Saucedo T. (1989) Internal fixation of pelvic ring fractures. Clin Orthop 242:83–97.

13.

Smith HE, Yuan PS, Sasso R, et al. An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine. 2006;31:234–8.CrossRef

14.

Lee JJ, Rosenbaum SL, Martusiewicz A, et al. Transsacral screw safe zone size by sacral segmentation variations. J Orthop Res. 2015;33:277–82. https://doi.org/10.1002/jor.22739.CrossRefPubMed

15.

Letournel E. Pelvic fractures. Injury. 1978;10:145–8.CrossRef

16.

Carlson DA, Scheid DK, Maar DC, et al. Safe placement of S1 and S2 iliosacral screws: the “vestibule” concept. J Orthop Trauma. 2000;14:264–9.CrossRef

17.

Wagner D, Kamer L, Sawaguchi T, et al. Sacral bone mass distribution assessed by averaged three-dimensional CT models: implications for pathogenesis and treatment of fragility fractures of the sacrum. J Bone Jt Surg Am. 2016;98:584–90. https://doi.org/10.2106/JBJS.15.00726.CrossRef

18.

Mendel T, Appelt K, Kuhn P, Suhm N. Bony sacroiliac corridor. A virtual volume model for the accurate insertion of transarticular screws. Unfallchirurg. 2008;111:19–26. https://doi.org/10.1007/s00113-007-1386-4.CrossRefPubMed

19.

Gardner MJ, Morshed S, Nork SE, et al. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma. 2010;24:622–9. https://doi.org/10.1097/BOT.0b013e3181cf0404.CrossRefPubMed

20.

Tonetti J, Cloppet O, Clerc M, et al. Implantation of iliosacral screws. Simulation of optimal placement by 3-dimensional X-ray computed tomography. Rev Chir Orthop Reparatrice Appar Mot. 2000;86:360–9.PubMed

21.

Zwingmann J, Konrad G, Mehlhorn AT, et al. Percutaneous iliosacral screw insertion: malpositioning and revision rate of screws with regards to application technique (navigated vs. conventional). J Trauma. 2010;69:1501–6. https://doi.org/10.1097/TA.0b013e3181d862db.CrossRefPubMed

22.

Verbeek J, Hermans E, van Vugt A, Frölke JP. Correct positioning of percutaneous iliosacral screws with computer-navigated versus fluoroscopically guided surgery in traumatic pelvic ring fractures. J Orthop Trauma. 2016;30:331–5. https://doi.org/10.1097/BOT.0000000000000502.CrossRefPubMed

23.

Zwingmann J, Südkamp NP, König B, et al. Intra- and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures: results from the German Pelvic Trauma Registry. Injury. 2013;44:1765–72. https://doi.org/10.1016/j.injury.2013.08.008.CrossRefPubMed

24.

Herman A, Keener E, Dubose C, Lowe JA. Simple mathematical model of sacroiliac screws safe-zone-easy to implement by pelvic inlet and outlet views. J Orthop Res. 2016;35(7):1478–84. https://doi.org/10.1002/jor.23396.CrossRefPubMed

25.

Abdullah KG, Bishop FS, Lubelski D, et al. Radiation exposure to the spine surgeon in lumbar and thoracolumbar fusions with the use of an intraoperative computed tomographic 3-dimensional imaging system. Spine. 2012;37:E1074–8. https://doi.org/10.1097/BRS.0b013e31825786d8.CrossRefPubMed

26.

Gebhard FT, Kraus MD, Schneider E, et al (2006) Does computer-assisted spine surgery reduce intraoperative radiation doses? Spine 31:2024–2027. https://doi.org/10.1097/01.brs.0000229250.69369.ac(discussion 2028).CrossRefPubMed

Title: Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures
Authors: Josephine Berger-Groch
Marie Lueers
Johannes Maria Rueger
Wolfgang Lehmann
Darius Thiesen
Jan Philipp Kolb
Maximilian Johannes Hartel
Lars Gerhard Grossterlinden
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-018-0990-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures

Abstract

Introduction

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Ankle ultrasound for detecting anterior talofibular ligament tear using operative finding as reference standard: a systematic review and meta-analysis

Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients

Monotrauma is associated with enhanced remote inflammatory response and organ damage, while polytrauma intensifies both in porcine trauma model

Incidence and treatment of femur fractures in adults with osteogenesis imperfecta: an analysis of an expert clinic of 216 patients

Displaced medial clavicle fractures: operative treatment with locking compression plate fixation

Contributing factors in the development of acute lung injury in a murine double hit model