title: Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation.
abstract: Percutaneous fixation of pelvic and acetabular fractures are technically demanding procedures, and high rates of screw misplacement and potential neurovascular complications have been reported. One hundred and sixty two screws from a prospectively collected database were analysed to evaluate the accuracy of a fluoroscopically assisted computer navigated technique to insert a cannulated screw to treat pelvic and acetabular fractures. Actual screw position and trajectory with the intraoperative surgical plan stored in the navigation computer. The actual screw position differed from the surgical plan by a mean of 3.9 mm, with a mean 1.4 degree difference in screw trajectory. Post operative CT analysis of patients showed 10 screws perforated cortical bone. Our results show that the use of computer navigation can aid in the accurate placement of percutaneous screws along a predefined plan. It is still possible to incorrectly place a screw and great care needs to be taken with the surgical plan and also to understand the complex anatomy of the bony pelvis.
authors: Department of Orthopaedics, Royal Melbourne Hospital, Grattan Street, Parkville 3050, VIC, Australia. Electronic address: minleong@doctors.org.uk.
authors: James Min-Leong
authors: JM
authors: Wong
authors: Department of Orthopaedics, Royal Melbourne Hospital, Grattan Street, Parkville 3050, VIC, Australia.
authors: Sam
authors: S
authors: Bewsher
authors: Department of Internal Medicine, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
authors: Jielin
authors: J
authors: Yew
authors: Department of Orthopaedics, Royal Melbourne Hospital, Grattan Street, Parkville 3050, VIC, Australia.
authors: Andrew
authors: A
authors: Bucknill
authors: Department of Surgery, Epworth Healthcare, University of Melbourne, 89 Bridge Rd, Richmond 3121, VIC, Australia.
authors: Richard
authors: R
authors: de Steiger
mesh_terms: D000077:Acetabulum / Q000473:pathology* / 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 / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
keywords: Navigation; Pelvic fracture; Sacroiliac screws