title: Correct Positioning of Percutaneous Iliosacral Screws With Computer-Navigated Versus Fluoroscopically Guided Surgery in Traumatic Pelvic Ring Fractures.
abstract: OBJECTIVE
  To assess the correct positioning of iliosacral screw in patients with unstable traumatic pelvic ring injury by comparing fluoroscopically guided computer-navigated surgery (CNS) with conventional fluoroscopy (CF) through reviewing postoperative computed tomography (CT) and clinical indicators.
  
  
  METHODS
  A comparative multicenter cohort study.
  
  
  METHODS
  Two level I Trauma Centers in the Netherlands.
  
  
  METHODS
  The computer-navigated group (n = 56) and the CF group (n = 24) were comparable regarding age (mean, 43 years), sex (58%, male), body mass index (25 kg/m), injury severity score (27), injury-to-surgery interval (7 days), and Orthopaedic Trauma Association classification (40% 61-B, 60% 61-C).
  
  
  METHODS
  The position of the iliosacral screws was evaluated on postoperative CT. In addition, clinical morbidity and reoperation were assessed.
  
  
  RESULTS
  In the CNS group, a total of 111 screws were placed (2.0 per patient), of which 83% were placed correctly. In the CF group, 39 screws (1.6 per patient) were placed, 82% of them correctly.Inadequate fixation included neural foramina hit [12 screws (11%) in the CNS group versus 3 screws (8%) in the CF group, P = 0.76] and extraosseous dislocation [7 screws (6%) vs. 4 screws (10%), respectively, P = 0.47]. Five patients required reoperation, all in the CNS group, P = 0.32. We observed more adequate positioning with increased surgical experience, P = 0.12.
  
  
  CONCLUSIONS
  In contrast to what has been suggested by previous studies, we found no benefit from computer-navigated iliosacral screw fixation compared with fluoroscopically guided surgery regarding the correct positioning of iliosacral screw on postoperative CT and related morbidity.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; and †Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Verbeek
authors.forename: Erik
authors.initials: E
authors.lastname: Hermans
authors.forename: Arie
authors.initials: A
authors.lastname: van Vugt
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Frölke
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009426:Netherlands; D056888:Patient Positioning; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D011379:Prognosis; D012447:Sacrum; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014193:Trauma Centers; D016896:Treatment Outcome