title: Three-dimensional fluoroscopy-navigated percutaneous screw fixation of acetabular fractures.
abstract: OBJECTIVE
  Anatomic reduction and articular restoration after acetabular fractures occur (Ac-Fxs) are accepted predictors for good function and slow progression of posttraumatic osteoarthritis of the hip. The aim of this study was to retrospectively analyze Ac-Fxs, which were treated with closed reduction and percutaneous (three-dimensional) fluoroscopy-based navigated screw fixation.
  
  
  METHODS
  Level 4, retrospective clinical and radiographic assessment.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Twelve patients (male/female: 9/3; mean age: 60 years; range: 16-80 years) with moderately displaced Ac-Fxs were included.
  
  
  METHODS
  In enrolled patients, the treatment involved percutaneous three-dimensional fluoroscopy-based navigated lag screw positioning. Closed reduction was achieved by lag screws, or reduction was aided by the insertion of percutaneous Schanz pins.
  
  
  METHODS
  The quality of the reduction and screw positions were assessed using intraoperative and postoperative computed tomography scans. Functional outcome was assessed using the Harris hip score, the visual analog scale for pain, and the Tegener activity scale.
  
  
  RESULTS
  A total of 22 periacetabular screws were placed (mean: 1.8 ± 1.1 screws/patient, range: 1-5). The mean follow-up was done for 30 (16-72) months. The postoperative reduction was anatomical in all patients, and the mean fracture displacement was significantly reduced (gap: 4.1 ± 1.8 mm to 0.4 ± 0.7 mm/step: 1.4 ± 0.6 mm to 0.2 ± 0.4 mm). No secondary dislocations or malunions/nonunions were found. All screws correctly addressed the fracture morphology and corresponded to preoperative planning. The Harris hip score, the visual analog scale (motion), and Tegener activity scale showed excellent to very good results (92.4 ± 6.8, 1.9 ± 1.3, and 3.8 ± 1.6, respectively).
  
  
  CONCLUSIONS
  The navigated, percutaneous screw fixation of selected Ac-Fxs is a promising method that allows for closed reduction and fixation while obtaining a very good radiographic and functional outcome.
  
  
  METHODS
  Therapeutic level 4.
authors.affiliation: Center for Musculoskeletal Surgery and Julius Wolff Institute, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schwabe
authors.forename: Burak
authors.initials: B
authors.lastname: Altintas
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Schaser
authors.forename: Claudia
authors.initials: C
authors.lastname: Druschel
authors.forename: Christian
authors.initials: C
authors.lastname: Kleber
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Haas
authors.forename: Sven
authors.initials: S
authors.lastname: Maerdian
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D055815:Young Adult