Percutaneous antegrade screwing for anterior column fracture of acetabulum with fluoroscopic-based computerized navigation.
BACKGROUND
Open reduction and internal fixation has been the gold standard for displaced fracture involving weightbearing dome and fractures with intra-articular fragments. However, extensile exposure can lead to complications. Fracture with minimal displacement can be fixed by a minimally invasive method. Percutaneous screwing for an anterior column fracture of acetabulum under conventional 2D fluoroscopy is a demanding technique. With fluoroscopic-based computerized navigation, we can determine the position of a screw real time intra-operatively with less exposure to radiation. We proposed that a fluoroscopy-based computerized navigational system would simplify operation procedures. The purpose of this study is to test the application of the fluoroscopy-based computerized navigational system for anterior column fracture of acetabulum.


METHODS
A prospective cohort study was conducted. Three patients with mildly displaced or non-displaced anterior column fracture of acetabulum were treated with a retrograde lag screw under a fluoroscopy-based computer navigation system. There were two males and one female with a mean age of 39 years and all patients were followed up for more than 1 year. Patients were allowed to perform joint movement exercises and to walk with partial weightbearing on the first day post-operatively.


RESULTS
The mean operation time was 40 min (range 30-45 min) from the use of fluoroscopy to wound closure and the mean total fluoroscopy time was 38 s (range 35-45 s). Total blood loss was less than 10 ml. The patients were pain free 1 week after the operation and had good functional recovery thereafter. No complication was noted postoperatively.


CONCLUSIONS
Though the indication for this procedure is limited, we think that there should be potential to apply the screw with less radiation by fluoroscopic-based computerized navigation. Once anatomic reduction can be achieved by the close method in the anterior column fracture of the acetabulum, percutaneous screw fixation under fluoroscopic-based computerized navigation could be a reliable method; however; validating the position of the guide pin and screw by fluoroscopy is suggested.
Lin
Yu-Chuan
YC
Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Chen
Chung-Hwan
CH
Huang
Hsuan-Ti
HT
Chen
Jian-Chih
JC
Huang
Peng-Ju
PJ
Hung
Shao-Hung
SH
Liu
Ping-Cheng
PC
Lee
Tsung Ying
TY
Chen
Lan-Hui
LH
Chang
Je-Ken
JK
D000077:Acetabulum / Q000293:injuries* / Q000601:surgery; D000328:Adult; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors