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3D image guidance for transiliosacral screw fixation enabled more accurate screw placement in S1 and S2 vertebrae. However, radiation exposure in 3D-navigation was excessive; thus, we recommend avoiding 3D-navigation in young patients. A primary advantage of 3D-navigation was that the operating team could leave the room during the scan; thus, it reduced their radiation exposure. Moreover, the time required for screw insertion with 3D-navigation was similar to that required in the conventional technique; thus, 3D-navigation is recommended for older patients.

BackgroundAccuracy evaluation of navigated image free placement of double cortical fixation buttons for coracoclavicular tunnel position in comparison to conventional drill guide based placement.MethodsTwenty-six patients with acute acromioclavicular joint instability were included in this non-randomized cohort study. All patients were treated with a Double- TightRope technique. In 13 cases the conventional drill guide based placement was used (group 1). In 13 patients surgery was performed as a navigated procedure with a fluoro-free optoelectronic system (group 2). The number of coracoclavicular drillings per patient (First pass accuracy; FPA (%)) was documented, the subcoracoidal position of the fixation buttons has been evaluated and graded as “intended position achieved (IPA)” or “intended position not achieved (IPnA)”.ResultsIn group 1 drilling had to be repeated in four patients (30.8 %) to achieve proper placement of the subcoracoidal fixation buttons. 100 % first pass accuracy was observed in group 2 (p = 0.03). In group 1, the intended position of the subcoracoid buttons was not achieved (IPnA) in six patients (46.2 %). In group 2 all intended positions were achieved (p = 0.005).ConclusionArthroscopic controlled fluoro-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first pass accuracy in comparison to conventional drill guide based placement. Therefore the navigation enables a precise position of the drill holes, may reduce the risk of an iatrogenic coracoid fracture and migration of fixation devices.Trial registrationLocal institutional review board No. 061-14-10032014

ZusammenfassungMonteggia-Verletzungen umfassen osteoligamentäre Kombinationsverletzungen des proximalen Unterarms, die zu dauerhaft einschränkenden Folgezuständen führen können. Das Verständnis des Verletzungsbildes sowie die schrittweise Rekonstruktion, unter besonderer Beachtung von Anatomie und Biomechanik, stellt ein Grundpfeiler der erfolgreichen Versorgung dar. Dieser Beitrag soll besonders über die in der Literatur nicht eindeutig verwendeten Begrifflichkeiten aufklären und Behandlungsstrategien und erwartbare Prognosen aufzeigen.

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