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[Precise sacroiliac joint screw insertion without computed tomography, digital volume tomography or navigation

B Roetman1, I Ilchuk2, B Khatib2

  • 1Klinik für Orthopädie und Unfallchirurgie, Mathias-Spital Rheine, Frankenburgstr. 31, 48431, Rheine, Deutschland. b.roetman@mathias-spital.de.

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Summary

This study demonstrates precise sacroiliac screw placement using preoperative planning with Digital Imaging and Communications in Medicine (DICOM) workstations. This method improves accuracy without advanced intraoperative technology, reducing complications in pelvic fracture surgery.

Keywords:
Bone screwsDiagnostic imagingFluoroscopyMalpositionPreoperative procedures

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Area of Science:

  • Orthopedic Surgery
  • Medical Imaging
  • Trauma Management

Background:

  • Accurate sacroiliac screw placement is crucial for pelvic fracture fixation.
  • Advanced navigation systems and intraoperative imaging enhance accuracy but are not always available.
  • Preoperative planning using DICOM workstations offers a viable alternative for improving surgical precision.

Purpose of the Study:

  • To evaluate the effectiveness of preoperative planning with a DICOM workstation for sacroiliac screw positioning.
  • To assess the feasibility of this technique in the absence of intraoperative CT, DVT, or navigation systems.

Main Methods:

  • Utilized preoperative CT datasets on a DICOM workstation to create virtual standard X-rays.
  • Projected critical landmarks, including screw entry and exit points, onto virtual images.
  • Performed intraoperative navigation by comparing virtual X-rays with C-arm fluoroscopy.

Main Results:

  • 26 sacroiliac screws were inserted in 19 patients over 13 months.
  • Postoperative CT scans showed precise screw placement in all but three screws.
  • No revisions or neurological deficits were required, with an average operating time of 33 minutes.

Conclusions:

  • Preoperative planning with DICOM workstations enables accurate sacroiliac screw placement.
  • This technique is a cost-effective alternative to advanced intraoperative navigation for pelvic fracture fixation.
  • The method simplifies surgical procedures and maintains a high level of safety.