Iliosacral screw insertion using CT-3D-fluoroscopy matching navigation.

Area of Science:

• Orthopedic surgery
• Medical imaging
• Surgical navigation

Background:

• Percutaneous iliosacral screw insertion demands significant surgical expertise and anatomical knowledge.
• Existing navigation systems still present challenges in achieving precise entry points and trajectories.
• Three-dimensional (3D) fluoroscopic navigation combined with computed tomography (CT)-based planning offers a potential solution.

Purpose of the Study:

• To evaluate the accuracy of 3D fluoroscopic navigation for iliosacral screw placement in displaced cadaveric pelvic fractures.
• To report the technical and clinical outcomes of using CT-3D-fluoroscopy matching navigation for percutaneous iliosacral screw insertion.

Main Methods:

• Simulated posterior pelvic ring disruptions with varying vertical displacements in cadaveric pelvic rings.
• Assessed target registration error using fiducial markers and fluoroscopic imaging.
• Applied CT-3D-fluoroscopy matching navigation for percutaneous iliosacral screw placement in six patients with pelvic ring fractures (AO-OTA types B2 and C1).

Main Results:

• Mean target registration error over the sacrum was 1.2mm, unaffected by fracture type or displacement.
• All 12 inserted iliosacral screws were accurately positioned in the clinical series.
• No postoperative complications, such as nerve palsy, were observed.

Conclusions:

• The CT-3D-fluoroscopy matching navigation system demonstrates accuracy and robustness across various pelvic fracture types and displacements.
• Percutaneous iliosacral screw insertion using this navigation system is clinically feasible and safe.