Minimally invasive fluoro-navigation screw fixation for the treatment of pelvic ring injuries

Intensive use of intraoperative fluoroscopy is mandatory to achieve good accuracy and avoid neural or vascular injury and may prolong surgical time and increase exposure-related hazards. New methods of percutaneous treatment in conjunction with innovative fluoroscopy-based computerized navigation have evolved in an attempt to overcome the existing difficulties. This report described our experience in applying fluoroscopic surgical navigation technique and evaluated its clinical application to pelvic ring injuries, including its feasibility, merits and limitations. Twenty-two patients with pelvic ring injuries were treated with percutaneous pubic ramus screw and sacroiliac screw techniques under the guidance of a fluoroscopy-based navigation system. A total of forty-four screws were inserted, including twenty-seven pubic ramus screws and seventeen sacroiliac screws. The average operation time and the average fluoroscopy time per screw were 23.6 minutes and 22.2 seconds respectively. Compared to the final position of the screw, the average deviated distance of wire tip was 2.8 mm and the average trajectory difference was 2.6°. A ventral cortex perforation of the sacrum was found in one sacroiliac screw without any clinical symptoms. No superficial or deep infection occurred. No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw fixation of pubic ramus fractures, sacroiliac disruptions, or sacral fractures. Our results showed that fluoroscopy-based navigation technique for the pelvic ring injuries could become a safe and effective alterative method for the treatment of pelvic ring injuries in some selected patients.