Screw placement for acetabular fractures: which navigation modality (2-dimensional vs. 3-dimensional) should be used?...

Area of Science:

• Orthopedic Surgery
• Medical Imaging
• Surgical Navigation

Background:

• Acetabular fractures require precise screw placement for optimal outcomes.
• Image guidance systems, including 2D and 3D fluoroscopy, are used to aid screw navigation.
• Evaluating the comparative efficacy of different image guidance techniques is crucial for surgical planning.

Purpose of the Study:

• To compare the effectiveness of 2-dimensional (2D) versus 3-dimensional (3D) fluoroscopic navigation for screw placement in acetabular fracture surgery.
• To assess procedure duration, fluoroscopy time, and accuracy of guide wire placement between 2D and 3D navigation techniques.

Main Methods:

• Guide wires were placed in synthetic pelvis models using either 2D or 3D fluoroscopic navigation.
• Procedure time, image acquisition time, and cumulative fluoroscopy time were measured.
• Accuracy of guide wire placement was evaluated visually and via 3D cone-beam scans, noting intra-articular misplacements.

Main Results:

• The 3D navigation group demonstrated a significantly reduced overall procedure time compared to the 2D group (50.11 min vs. 63.42 min).
• While image acquisition time showed a trend towards reduction with 3D, cumulative fluoroscopy time significantly increased (64 sec vs. 13 sec) due to 3D scans.
• The 3D navigation procedure resulted in higher accuracy, with fewer misplacements (2.5% vs. 10%) and more perfect placements.

Conclusions:

• Both 2D and 3D navigation techniques effectively prevent intra-articular penetration during drilling for acetabular fractures.
• 3D image-based navigation offers superior accuracy in screw placement compared to 2D navigation.
• 3D navigation is particularly recommended for challenging screw paths, such as the infra-acetabular corridor.