Fluoroscopically Assisted Computer Navigation Enables Accurate Percutaneous Screw Placement For Pelvic and Acetabular Fracture Fixation (original) (raw)
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Fluoroscopic Positioning of Sacroiliac Screws in 88 Patients
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
Fluoroscopic placement of guided sacroiliac screws is a well-established method of fixation of the posterior pelvic ring, leading to biomechanical results similar to an intact pelvic ring. The main problem still remains the risk of neurological injury due to the penetration of the intervertebral root or the vertebral canal.
Injury, 2018
Percutaneously-placed sacroiliac (SI) screws are currently the gold-standard fixation technique for fixation of the posterior pelvic ring. The relatively high prevalence of sacral dysmorphism in the general population introduces a high risk of cortical breach with resultant neurovascular damage. This study was performed to compare the accuracy of SI screw placement with and without the use of intraoperative navigation, as well as to externally validate the sacral dysmorphism score in a trauma patient cohort. All trauma patients who underwent sacroiliac screw fixation for pelvic fractures at a level 1 trauma centre over a 6 year period were identified. True axial and coronal sacral reconstructions were obtained from their pre-operative CT scans and assessed qualitatively and quantitatively for sacral dysmorphism - a sacral dysmorphism score was calculated by two independent assessors. Post-operative CT scans were then analysed for breaches and correlated with the hospital medical rec...
The standard starting point for the percutaneous sacroiliac screw insertion defined by Matta and Saucedo was initially determined for surgeries performed in a prone position. Still, the technique has also been used in surgeries performed in a supine position. Therefore, the cadaveric study aimed to determine the best entry point for the percutaneous insertion of sacroiliac screws depending on the patient's positioning for surgery. K-wires were percutaneously inserted into the sacral body of eight human cadavers. In addition to the standard sacroiliac screw entry point, points located 1 cm and 2 cm cranially from along the line, prolonging the femoral axis, were studied. The K-wires were inserted into the studied entry points on the right side in a supine position and on the left side of the same cadaver in a prone position. The placement of the K-wires was assessed using radiographic imaging and cadaver dissection. The analysis revealed that all three studied entry points enable...
Injury, 2015
Sacroiliac-percutaneous-screw-placement (SPSP) for unstable-posterior-pelvic-ring-injuries (UPPRI) might be associated with severe neurovascular complications because of screw-mal-position. The aim of the present study was to analysis the effectivity of computer-tomography-guided (CTG)-SPSP including accuracy of screw-placement, quality of injury-reduction and documentation of perioperative-complications. Additionally, procedure-dependent radiation-dose and outcome should be analysed. A consecutive cohort of 71 patients with UPPRI was operated by CTG-SPSP at a single trauma level 1 hospital. 136 sacroiliac screws were inserted to S1 and S2. Postoperatively, by the use of a computerised-radiologic-work-station all screws were visualised three-dimensionally. Their distancesmin to the sacral-borders in anterior-posterior and cranio-caudal direction as well as to the neuroforamen S1/S2 were determined. After CTG-SPSP, injury-dislocation in anterior-posterior and cranio-caudal direction ...
Spine, 2015
Study Design. An anatomic and radiographic study of placement of sacroiliac screws. Objective. The aim of this study was to quantitatively assess the risk of partial cutout of sacroiliac screws from the sacral ala slope via inlet and outlet view. Summary of Background Data. The partial cutout of sacroiliac screws from the superior surface of sacral ala can jeopardize the L5 nerve root, which is difficult to identify on the pelvic inlet and outlet views. Methods. Computed tomography images of 60 patients without pelvic ring deformity or injury were used to measure the width (on inlet view) and height (on outlet view) of the sacral ala. The angle of the sacral ala slope was measured on lateral view. According to the measured parameters, the theoretical safe trajectories of screw placement were calculated using inverse trigonometric functions. Under fluoroscopic guidance, a sacroiliac screw was placed close to the midline on both inlet and outlet views, including posterosuperior, posteroinferior, anterosuperior, and anteroinferior regions to the midline. The incidence of screw partial cutout from the superior surface of sacral ala was identified. Results. The measured widths and heights of the sacral alas were 28.1 AE 2.8 and 29.8 AE 3.1 mm, respectively. The average angle between the superior aspect of the S1 vertebral body and the superior aspect of the sacral ala was 37.2 AE 2.5 degrees. The rate of partial cutout of the screws from the superior surface of sacral ala slope was 12.5% (5/40) in posterosuperior, 0% (0/40) in posteroinferior, 70% (28/40) in anterosuperior, and 20% (8/ 40) in anteroinferior. Conclusion. To avoid the risk of partial cutout from sacroiliac screw placement, more precise description should be added to the conventional description: the sacroiliac screws should be placed at the inferior half portion on outlet view and at the posterior half portion on inlet view.
Injury, 2015
43 44 Introduction: Minimal-invasive placement of screws into the posterior column of the 45 acetabulum (PC) is challenging. Due to the saddle-shaped curvature of the medial cortical 46 border of the PC, the standard fluoroscopic views of the pelvis cannot provide the desired safety 47 65 Conclusions: The "Down the PC" view is a useful addendum in the orthopaedic trauma 66 surgeon's tool box. Using simple landmarks, it is easily to reproduce and thereby shows 67 excellent accuracy and inter-observer agreement in order to detect medial perforation or intra-68 articular implant position. 3 A c c e p t e d M a n u s c r i p t The "Down the PC" view 157 1.00 to 1.00, Cronbach's alpha 1.00) for wire perforation and an ICC of 0.869 (95% CI, 0.783 to 158 0.927, Cronbach's alpha 0.954) for penetration of the joint.
Archives of Orthopaedic and Trauma Surgery, 2012
Introduction Percutaneous retrograde screw fixation for acetabular fractures is a demanding procedure due to the complex anatomy of the pelvis and the varying narrow safe bony corridors. Limited information is available on optimal screw placement and the geometry of safe zones for screw insertion in the pelvis. Methods Three-dimensional reconstructions of 50 consecutive CT scans of polytrauma patients (35 males, 15 females) were used to introduce three virtual CAD bolts (representing screws) into the anterior column (superior ramus of the pubic bone), posterior column (the ischial bone) and the supraacetabular region, as performed during percutaneous screw fixation. The three-dimensional (3D) position of these screws was evaluated with a computer software (MIMICS) after virtual optimal insertion. The 3D position, the narrowest zone and the distance to the hip joint of the two columns and the supraacetabular region were defined. Results The mean maximal screw length for the three virtual screws measured between 107.4 and 148 ± 18.7 mm. The narrowest zone of the pelvic bone (superior pubic ramus) had a width of 9.2 ± 2.4 mm. The average distances between the bolts and the hip joint were 3.9 and 19.4 ± 7.4 mm. For the anterior column (superior pubic ramus) screw, the mean lateral angle to the sagittal midline plane was 39.0 ± 3.2°and the mean posterior angle to the transversal midline plane was 15.1 ± 4.0°. The mean supraacetabular screw angles measured 22.4 ± 3.4°(medial), 35.3 ± 4.6°(cranial) and the mean angles for the ischial screw were 12.0 ± 5.4°(posterior) and 18.4 ± 4.0°( lateral). Conclusions The zones for safe screw positioning are very narrow, making percutaneous screw fixation of the acetabulum a challenging procedure. The predefined angles for the most frequently positioned percutaneous screws may aid in preoperative planning, decrease operative and radiation times and help to increase safe insertion of screws.