Major improvement using peroperative 3D compared to 2D imaging for SI screw fixation in traumatic pelvic fractures

Pelvic fractures, though accounting for only 3% of skeletal injuries, carry a high mortality rate, primarily due to the associated risk of hemodynamic instability. Sacroiliac (SI) screw fixation is a common surgical intervention, which can be technically challenging due to the complex pelvic anatomy. Imaging techniques have evolved from 2D to 3D imaging for its improved accuracy in screw placement. The impact of this transition for SI screw placement was evaluated.

A single-center observational retrospective study was performed between 2013 and 2023. Patients ≥ 18 years who underwent SI screw placement following pelvic injuries were analyzed. 2D imaging was used until 2021, after which 3D imaging was implemented. Outcomes included the need for revision surgery during initial admission and < 18 months after trauma.

2D imaging was used in 42 patients and 3D imaging in 44 patients. Baseline characteristics and injury severity of both groups were comparable. In the 2D group, 18 patients (42.9%) had suboptimal placement of the SI screw. Of these, 3 (7.1%) required revision surgery due to malpositioned screws. In contrast, no patients (0.0%) in the 3D group had suboptimally positioned screws or underwent revision surgery, (p < 0.001, p = 0.22).

Intraoperative 3D imaging enhanced the accuracy of SI screw placement, leading to an encouraging reduction in suboptimally placed SI screws. This improvement contributed a trend of fewer secondary revision surgeries and complications. These results suggested benefits of applying 3D imaging broadly.