Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study.
OBJECTIVE
To evaluate the accuracy of computer-assisted sacral screw fixation compared with conventional techniques in the dysmorphic versus normal sacrum.


METHODS
Review of a previous study database.


METHODS
Database of a multinational study with 9 participating trauma centers.


METHODS
The reviewed group included 130 patients, 72 from the navigated group and 58 from the conventional group. Of these, 109 were in the nondysmorphic group and 21 in the dysmorphic group.


METHODS
Placement of sacroiliac (SI) screws was performed using standard fluoroscopy for the conventional group and BrainLAB navigation software with either 2-dimensional or 3-dimensional (3D) navigation for the navigated group.


METHODS
Accuracy of SI screw placement by 2-dimensional and 3D navigation versus conventional fluoroscopy in dysmorphic and nondysmorphic patients, as evaluated by 6 observers using postoperative computerized tomography imaging at least 1 year after initial surgery. Intraobserver agreement was also evaluated.


RESULTS
There were 11.9% (13/109) of patients with misplaced screws in the nondysmorphic group and 28.6% (6/21) of patients with misplaced screws in the dysmorphic group, none of which were in the 3D navigation group. Raw agreement between the 6 observers regarding misplaced screws was 32%. However, the percent overall agreement was 69.0% (kappa = 0.38, P < 0.05).


CONCLUSIONS
The use of 3D navigation to improve intraoperative imaging for accurate insertion of SI screws is magnified in the dysmorphic proximal sacral segment. We recommend the use of 3D navigation, where available, for insertion of SI screws in patients with normal and dysmorphic proximal sacral segments.


METHODS
Therapeutic level I.
*Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, San Francisco General Hospital, San Francisco, CA; †Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA; ‡Orthopaedic Trauma Department, Hannover Medical School, Hannover, Germany; §Department of Trauma and Restorative Surgery, BGU Hospital Tübingen, Tübingen, Germany; ‖Clinic of Trauma Surgery and Orthopaedic Surgery, BG Clinic Ludwigshafen, Ludwigshafen, Germany; ¶Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; **AO Clinical Investigation and Documentation, Dübendorf, Switzerland; and ††Clinic for Trauma Surgery, Hand Surgery, Plastic Surgery and Reconstructive Surgery, Ulm University, Ulm, Germany.
Amir
A
Matityahu
David
D
Kahler
Christian
C
Krettek
Ulrich
U
Stöckle
Paul Alfred
PA
Grutzner
Peter
P
Messmer
Jan
J
Ljungqvist
Florian
F
Gebhard
D001863:Bone Screws; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery; D021621:Imaging, Three-Dimensional; D016032:Randomized Controlled Trials as Topic; D012447:Sacrum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D025321:Surgery, Computer-Assisted