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Published on: August 6, 2019
Computer-assisted periacetabular screw placement: Comparison of different fluoroscopy-based navigation procedures
Björn Gunnar Ochs1, Christoph Gonser, Thomas Shiozawa
1BG Trauma Centre, Eberhard Karls University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany.
Injury
|August 24, 2010
Summary
3D fluoroscopy navigation improves accuracy and reduces perforation rates for periacetabular screw placement in acetabular fractures. While increasing procedure time, it offers superior precision, especially for posterior column screws.
Area of Science:
- Orthopedic Surgery
- Medical Imaging
- Surgical Navigation
Background:
- Open reduction and internal fixation is the gold standard for acetabular fractures.
- Minimally invasive percutaneous screws offer an alternative but require precise placement due to complex pelvic anatomy.
Purpose of the Study:
- To evaluate the accuracy of periacetabular screw placement using different fluoroscopy-based navigation techniques compared to the conventional method.
- To assess screw perforation rates and deviation severity in relation to pre-defined placement corridors.
Main Methods:
- 210 periacetabular screws (anterior column, posterior column, supraacetabular ilium) were placed in pelvic models and cadavers.
- 3D-fluoroscopy, 2D-fluoroscopy, and conventional techniques were compared.
- Screw position accuracy, perforation rates, insertion time, and radiation exposure were analyzed postoperatively using Iso-C(3D) scans and image fusion.
Main Results:
- 3D fluoroscopy navigation significantly reduced screw perforation rates (7%) compared to 2D fluoroscopy (20%).
- Screw deviation severity was significantly lower with 3D navigation versus 2D or conventional techniques for all screws.
- Posterior column screws showed significantly lower deviation with 3D navigation; anterior column screws showed similar deviation across methods.
Conclusions:
- Percutaneous periacetabular screw placement is technically demanding.
- 3D fluoroscopy-based navigation is the preferred method for image guidance in acetabular surgery, offering higher accuracy and lower perforation rates, particularly for posterior column screws.
