Abstract
The current gold standard for operatively treated acetabular fractures is open reduction
and internal fixation. Fractures with minimal displacement may be stabilised by minimally
invasive methods such as percutaneous periacetabular screws. However, their placement
is a demanding procedure due to the complex pelvic anatomy. The aim of this study
was to evaluate the accuracy of periacetabular screw placement assessing pre-defined
placement corridors and comparing different fluoroscopy-based navigation procedures
and the conventional technique.
For each screw an individual periacetabular placement corridor was preoperatively
planned using the planning software iPlan CMF© 3.0 (BrainLAB). 210 screws (retrograde anterior column screws, retrograde posterior
column screws, supraacetabular ilium screws) were placed in an artificial Synbone
pelvis model (30 hemipelves) and in human cadaver specimen (30 hemipelves). 2D- and
3D-fluoroscopy-based navigation procedures were compared to the conventional technique.
Insertion time and radiation exposure to specimen were also recorded. The achieved
screw position was postoperatively assessed by an Iso-C3D scan. Perforations of bony cortices or articular surfaces were analysed and the screw
deviation severity (difference of the operatively achieved screw position and the
preoperatively planned screw position in reference to the pre-defined corridors) was
determined using image fusion.
Using 3D-fluoroscopy-based navigation, the screw perforation rate (7%) was significantly
lower compared to 2D-fluoroscopy-based navigation (20%). For all screws, the deviation
severity was significantly lower using a 3D- compared to a 2D-fluoroscopy-based navigation
and the conventional technique. Analysing the posterior column screws, the screw deviation
severity was significantly lower using 3D- compared to 2D-fluoroscopy-based navigation.
However, for the anterior column screw, the screw deviation severity was similar regardless
of the imaging method. Despite the advantages of the 3D-fluoroscopy-based navigation,
this method led to significantly longer total procedure and fluoroscopic times, and
the applied radiation dose was significantly higher.
Percutaneous periacetabular screw placement is demanding. Especially for posterior
column screws, due to a lower perforation rate and a higher accuracy in periacetabular
screw placement, 3D-fluoroscopy-based navigation procedure appears to be the method
of choice for image guidance in acetabular surgery.
Keywords
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Article info
Publication history
Accepted:
July 28,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
