title: CT-3D-fluoroscopy matching navigation can reduce the malposition rate of iliosacral screw insertion for less-experienced surgeons.
abstract: OBJECTIVE
  The aim of the present study was to determine whether 3-dimensional (3D) fluoroscopic navigation combined with a preoperative computer tomography (CT)-based plan could enable surgeons to perform safe and reliable iliosacral screw insertion despite their limited experience.
  
  
  METHODS
  Eight pelvises with surrounding soft tissue donated from embalmed cadavers were used. Kirschner wires with a diameter of 3 mm were placed across the ilia bilaterally into the S1 and S2 vertebrae by 4 orthopaedic trainees. In 4 specimens, wires were placed across the right ilium using conventional technique and the left ilium using the CT-3D-fluoroscopy matching navigation system. In 4 other specimens, wires were placed across the right ilium using the 3D-fluoroscopic navigation system and the left ilium using the CT-3D-fluoroscopy matching navigation system. A postoperative CT-based analysis of wire localization was performed. The number of wire insertions until the final position check, operation duration, and radiation time and dose were also evaluated.
  
  
  RESULTS
  The percentage of wires inserted correctly was higher in the CT-3D-fluoroscopy matching navigated group (100%) than in the conventional technique group (50%) and 3D-fluoroscopic navigation group (50%). The number of wire insertions and radiation time were significantly lower with both navigation systems than with the conventional technique, whereas there was no significant difference between the navigation systems. There were no significant differences in operation time and radiation dose among the 3 groups.
  
  
  CONCLUSIONS
  The CT-3D-fluoroscopy matching navigation system reduced the malposition rate of percutaneous iliosacral screw insertion when performed by less experienced surgeons.
authors.affiliation: Departments of *Orthopaedic Surgery, and †Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Takao
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishii
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakai
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Sugano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002102:Cadaver; D002983:Clinical Competence; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D064847:Multimodal Imaging / Q000379:methods; D015203:Reproducibility of Results; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome