Effects of three-dimensional navigation on intraoperative management and early postoperative outcome after open reduction and internal fixation of displaced acetabular fractures.
BACKGROUND
This study was conducted to evaluate whether intraoperative procedure and/or early postoperative results after open reduction and internal fixation (ORIF) of displaced acetabulum fractures are influenced by the use of a three-dimensional (3D) image intensifier in combination with a navigation system.


METHODS
From January 2004 until December 2008, all patients with acetabular fractures were followed prospectively. From January 2004 until October 2006, all operations were performed under fluoroscopic control using a conventional two-dimensional image intensifier. Since October 2006, we regularly operate acetabular fractures with the intraoperative use of a navigation system and a 3D image intensifier. Pre- and postoperative computed tomography scans of the affected hip were obtained in all patients as were standard anterior-posterior radiographs and ala- and obturator views. All data collection was performed according to the guidelines of the "German Pelvic fracture study group."


RESULTS
In total, 68 patients with acetabular fractures were included in the study. A conventional image intensifier was used in 37 patients (group A) and a 3D image-based navigation was used in the remaining 31 patients (group B). In the navigated group, seven patients were assessed incapable of partial weight bearing. These patients underwent computer-assisted percutaneous screwing of their acetabular fracture. Using a navigation system in combination with a 3D image intensifier for ORIF of displaced acetabular fractures led to a significant increase in skin-to-skin time. Postoperative radiolographic analysis revealed an improvement in the quality of fracture reduction in the 3D navigation group. Navigation in combination with the 3D images of the ISO-C 3D limited the need for extended approaches. In addition, the complication rate in the navigated group was significantly lower.


CONCLUSIONS
We support the use of navigation systems and a 3D image intensifier as helpful tools during ORIF of displaced acetabular fractures.


METHODS
Therapeutic study, level III.
Clinic of Orthopaedics, Trauma and Spine Surgery, Ostalb-Klinikum Aalen, Aalen, Germany.
Michael
M
Oberst
Oliver
O
Hauschild
Lukas
L
Konstantinidis
Norbert P
NP
Suedkamp
Hagen
H
Schmal
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005858:Germany / Q000453:epidemiology; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011184:Postoperative Period; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult