2D computer navigation assisted iliosacral screw fixation in posterior pelvic ring injuries

Abstract

Introduction: Percutaneous osteosynthesis of the sacroiliac joint guided by fluoroscopy in posterior pelvic ring lesions, described by Matta in the 1990s, remains the gold standard technique. However, the development of novel techniques such as 2D/3D navigation-assisted or CT-assisted surgery brings improvements in terms of ease and safety.
Objective: To present the 2D navigation-assisted percutaneous sacro-iliac fixation technique, as well as the clinical and radiological results of the patients operated.
Materials and methods: Twenty-three patients with a diagnosis of posterior pelvic ring disruption (sacroiliac dislocation and/or fracture) operated by 2D navigation-assisted percutaneous fixation (Medtronic Synergy System) in our hospital from 2017 to present were reviewed. Demographic, classification, therapeutic variables and derived complications were collected. The modified POS (Multicenter Study Group Pelvis Outcome Scale) rating scale was used to assess clinical, radiological and social outcome.
Results: Eight patients had sacro-iliac dislocation and 15 had fracture through the sacrum. A total of 40 iliaosacral screws were implanted. The mean operative time was 20 min for each screw. An average of eight fluoroscopy pulses were required per procedure. There were three malpositioned screws (7.5%). Fifteen patients had good or excellent results on the POS form.
Conclusions: Navigation-assisted percutaneous iliaosacral fixation is an alternative to the classic method guided by radioscopy, with good results. It facilitates the surgeon the correct placement of the screws, shortening the surgical time and with less exposure to ionizing radiation. It is useful for all types of ring lesions and when reduction maneuvers are necessary.