Simone Ghisla 1 , Francesca Napoli 2 , Gyozo Lehoczky 3 , Marco Delcogliano 1 , Nermine Habib 1 , Michele Arigoni 4 , Giuseppe Filardo 5 , Christian Candrian 1 Show Affiliations »
Abstract
INTRODUCTION: Posterior pelvic ring fractures frequently pose a problem of stability with an elevated risk of complications. The traditional method of percutaneous sacroiliac (SI) stabilization with the use of fluoroscopic image amplifiers demands a high degree of experience and has an elevated risk of screws' malpositioning. HYPOTHESIS: Intraoperative 3D-CT scan coupled with a navigation system (O-Arm©) can allow screw fixation accuracy while limiting the risk of complications for the treatment of posterior pelvic ring fractures. MATERIAL AND METHODS: Patients with posterior pelvic ring fractures stabilized with percutaneous SI screws through O-Arm© navigation from August 2008 to December 2017 were analyzed. A modified Gras classification was used to determine screws' positioning under CT visualization, and intraoperative and early postoperative complications were documented. RESULTS: Among the 21 patients evaluated, 14 men and 7 women with a mean age of 57.8 years (range 25-91), receiving 39 screws, the rate of misplacement was low: 82% grade I, 15.4% grade II, and only 2.6% grade III. Only one patient underwent revision surgery, not because of misplacement but rather for a secondary implant loosening. No complications occurred in this series. DISCUSSION: This study documented a large series of patients treated for pelvic ring fractures using the intraoperative 3D-CT O-Arm© guided navigation. This surgical approach provided a precise and safe SI screw positioning with no complications. LEVEL OF EVIDENCE: IV, Retrospective study.
INTRODUCTION: Posterior pelvic ring fractures frequently pose a problem of stability with an elevated risk of complications. The traditional method of percutaneous sacroiliac (SI) stabilization with the use of fluoroscopic image amplifiers demands a high degree of experience and has an elevated risk of screws' malpositioning. HYPOTHESIS: Intraoperative 3D-CT scan coupled with a navigation system (O-Arm©) can allow screw fixation accuracy while limiting the risk of complications for the treatment of posterior pelvic ring fractures . MATERIAL AND METHODS: Patients with posterior pelvic ring fractures stabilized with percutaneous SI screws through O-Arm© navigation from August 2008 to December 2017 were analyzed. A modified Gras classification was used to determine screws' positioning under CT visualization, and intraoperative and early postoperative complications were documented. RESULTS: Among the 21 patients evaluated, 14 men and 7 women with a mean age of 57.8 years (range 25-91), receiving 39 screws, the rate of misplacement was low: 82% grade I, 15.4% grade II, and only 2.6% grade III. Only one patient underwent revision surgery, not because of misplacement but rather for a secondary implant loosening. No complications occurred in this series. DISCUSSION: This study documented a large series of patients treated for pelvic ring fractures using the intraoperative 3D-CT O-Arm© guided navigation. This surgical approach provided a precise and safe SI screw positioning with no complications. LEVEL OF EVIDENCE: IV, Retrospective study.
Copyright © 2018. Published by Elsevier Masson SAS.
Entities: Disease
Species
Keywords:
O-Arm(©); Posterior pelvic ring fracture; Sacro-liac screws fixation
Mesh： See more »
Year: 2018
PMID： 30081217 DOI： 10.1016/j.otsr.2018.07.006
Source DB: PubMed Journal: Orthop Traumatol Surg Res ISSN： 1877-0568 Impact factor: 2.256