Launching an Image-Guided Percutaneous Osteosynthesis Program: A PRISM-RE-AIM Implementation Framework

Image-guided percutaneous osteosynthesis (IGPO) is an emerging minimally invasive technique for stabilizing metastatic, insufficiency-related, and selected traumatic skeletal lesions. Although technical feasibility and clinical outcomes are increasingly reported, guidance on launching and sustaining IGPO programs remains limited. This expert narrative review proposes an implementation framework based on the Practical, Robust Implementation and Sustainability Model and Reach, Effectiveness, Adoption, Implementation, Maintenance. Key IGPO, musculoskeletal interventional radiology, and implementation-science publications were identified from PubMed and authors' reference libraries. Selected French and Canadian institutional experiences were synthesized through framework-guided author discussions. This approach was not a systematic review or formal qualitative study. The framework emphasizes institutional readiness, stakeholder engagement, patient selection, imaging and anesthesia access, staffing, radiation safety, adverse event monitoring, follow-up, and progressive scale-up. Suggested metrics include technical success, procedure duration, radiation exposure, adverse event grade, pain, mobility, length of stay, reintervention, and patient-reported outcomes.