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Updated: Mar 28, 2026
A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
Published on: January 6, 2023
Correct Positioning of Percutaneous Iliosacral Screws With Computer-Navigated Versus Fluoroscopically Guided Surgery
Jan Verbeek1, Erik Hermans, Arie van Vugt
1*Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; and †Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.
Objectives:
To assess the correct positioning of iliosacral screw in patients with unstable traumatic pelvic ring injury by comparing fluoroscopically guided computer-navigated surgery (CNS) with conventional fluoroscopy (CF) through reviewing postoperative computed tomography (CT) and clinical indicators.
Design:
A comparative multicenter cohort study.
Setting:
Two level I Trauma Centers in the Netherlands.
Patients:
The computer-navigated group (n = 56) and the CF group (n = 24) were comparable regarding age (mean, 43 years), sex (58%, male), body mass index (25 kg/m), injury severity score (27), injury-to-surgery interval (7 days), and Orthopaedic Trauma Association classification (40% 61-B, 60% 61-C).
Main Outcome Measurements:
The position of the iliosacral screws was evaluated on postoperative CT. In addition, clinical morbidity and reoperation were assessed.
Results:
In the CNS group, a total of 111 screws were placed (2.0 per patient), of which 83% were placed correctly. In the CF group, 39 screws (1.6 per patient) were placed, 82% of them correctly.Inadequate fixation included neural foramina hit [12 screws (11%) in the CNS group versus 3 screws (8%) in the CF group, P = 0.76] and extraosseous dislocation [7 screws (6%) vs. 4 screws (10%), respectively, P = 0.47]. Five patients required reoperation, all in the CNS group, P = 0.32. We observed more adequate positioning with increased surgical experience, P = 0.12.
Conclusions:
In contrast to what has been suggested by previous studies, we found no benefit from computer-navigated iliosacral screw fixation compared with fluoroscopically guided surgery regarding the correct positioning of iliosacral screw on postoperative CT and related morbidity.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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