Percutaneous screw fixation of the iliosacral joint: A case-based preoperative planning approach reduces operating time and radiation exposure

Ecker, Timo M.; Jost, Julien; Cullmann, Jennifer; Zech, Wolf-Dieter; Djonov, Valentin; Keel, Marius; Benneker, Lorin Michael; Bastian, Johannes Dominik

doi:10.1016/j.injury.2017.06.016

Cited by 13 publications

(9 citation statements)

References 47 publications

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“…In our retrospective study, each screw insertion in fluoroscopy group spent an average of 60 min, and needed an average of 15 times fluoroscopy, which was similar to other scholars [15,16]. However, in template group, each screw insertion just spent average 28 min and needed average 3 times fluoroscopy, which was similar to the results of Yang et al [17].…”

Section: The Advantage Of 3d-printed Template In Assisting Sacral-ilisupporting

confidence: 87%

Comparative study of sacroiliac screw placement guided by 3D-printed template technology and X-ray fluoroscopy

Zhou

Tian

Liu

et al. 2019

Arch Orthop Trauma Surg

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Objective To compare the clinical effect of 3D-printed template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screws placement. Design Institutional review board-approved retrospective analysis. Patients The clinical data of 31 cases of sacroiliac complex injury between January 2015 and December 2016 were analyzed. There were 16 patients, males 11 and females 5, who underwent surgery assisted by 3D-printed template in template group, and that of contemporaneous 15 patients, males 11 and females 4, who underwent traditional surgery were gathered as fluoroscopy group. All those patients were followed up for more than 6 months. Main outcome measures The operation time and X-ray fluoroscopy times for each screw placement, and the Matta and Majeed score were analyzed and the difference between the two group was tested. Results All cases were followed up for 6-20 months, average 11.4 ± 0.6 months. In template group, 19 screws were implanted. Each screw spent 25-38 min, average 27.2 ± 5.3 min, and need 2-5 times fluoroscopy, average 2.7 ± 0.5. The fracture reduction quality was evaluated by Matta score scale: excellent 10, well 4, fair 2, good rate 87.5%; and pelvic function were evaluated by Majeed score scale: excellent 11, well 3, fair 2, and good rate 87.5%. In fluoroscopy group, 17 screws were implanted. Each screw spent 45-70 min, average 60.3 ± 5.8 min, and needs 11-23 times fluoroscopy, average 15.4 ± 3.5. The fracture reduction quality was evaluated by Matta score scale: excellent 7, well 6, fair 2, and good rate 86.7%; and pelvic function was evaluated by Majeed score scale: excellent 6, well 6, fair 3, and good rate 80.0%. The difference in operation time, X-ray fluoroscopy times between template group and fluoroscopy group had statistical significance. But the Matta and Majeed score had no difference between two groups. Conclusion Compared with traditional surgery, 3D-printed template technology-assisted surgery for sacroiliac screws placement in sacroiliac complex injury patients possesses advantage such as shortened operation time and reduced X-ray exposure times. This technology improves the safety profile of this operation and should be further studied in future clinical applications.

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Section: The Advantage Of 3d-printed Template In Assisting Sacral-ilisupporting

confidence: 87%

Comparative study of sacroiliac screw placement guided by 3D-printed template technology and X-ray fluoroscopy

Zhou

Tian

Liu

et al. 2019

Arch Orthop Trauma Surg

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“…Iliosacral screw placement is regarded as a challenging procedure with the risk of damaging neurological and/or vascular structures. Several technologies have been developed to enhance the accuracy of iliosacral screw placement: planning tools [ 15 , 26 , 32 , 33 ], 3D-fluoroscopic navigation [ 34 ], CT-based navigation [ 35 , 36 ] and robot-assisted navigation [ 37 ]. Several authors comparing 2D-fluoroscopy with computer navigation prefer the navigation techniques, although screw perforations have been documented between 0 and 22.6% with the navigation technique [ 36 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study

Rommens

Nolte

Hopf

et al. 2020

Eur J Trauma Emerg Surg

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Introduction Iliosacral screw osteosynthesis is a well-accepted procedure for stabilization of sacral fractures and iliosacral (fracture) dislocations. Materials and Methods In this monocentric study, safety and efficacy of conventional 2D-fluoroscopic-guided iliosacral screw insertion were evaluated. Results During a 10-year period (2005-2014), 98 patients between the age of 18 and 65 years received 207 iliosacral screws in 101 procedures. Average patient age was 43.2 years. There were 46 Type B and 40 Type C injuries in the AO/OTA classification, nine patients had a fragility fracture of the pelvis. In three patients, primary radiological data were missing. The indication for surgical treatment was a sacral fracture in 97 patients, a pure iliosacral dislocation in 37 patients and a fracturedislocation in 31 patients. 70 procedures were performed with the patient in supine position, 31 with the patient in prone position. Surgery was done in a minimal-invasive technique in 76 patients, in 22 patients an open reduction was necessary before screw insertion. 81 patients received a unilateral, 17 patients a bilateral screw osteosynthesis. 199 screws were inserted in S1, only eight screws in S2. 65 patients received two screws unilaterally, ten patients two screws bilaterally. There were no vascular or neurologic complications. During in-hospital stay, there were seven complications, which needed 12 operative revisions: three wound infections, two hematomas, one screw malalignment and one early screw loosening. In 28 patients with 56 iliosacral screws, a pelvic CT-scan was performed during follow-up. A penetration of a cortical layer was diagnosed in 20 of these screws. All penetrations were seen in double screw osteosynthesis of S1. In none of the patients, complaints could be explained by the malalignment of these screws. Five operative revisions were performed during follow-up: two for screw loosening, two for fracture healing problems and one for screw malalignment. Metal removal was performed in 39 patients with 75 screws. 2D-fluoroscopic-guided iliosacral screw osteosynthesis is a safe and efficient procedure in clinical practice. Discussion A thorough preoperative evaluation of the morphology of the upper sacrum and careful operative procedure are indispensable. Fluoroscopic views in AP, lateral, inlet and outlet must allow recognition of all anatomical landmarks. The indication for double screw osteosynthesis in S1 should be taken with caution. Screw malalignments do not inevitably correlate with complaints.

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“…Gautier et al 38 reported that the failure rate of sacroiliac screw implantation was 2%-13%. Ecker et al 39 believed that preoperative determination of the nail entry point and angle was conducive to increasing the accuracy of the percutaneous sacroiliac screw, shortening the operation time, and minimizing the radiation exposure of patients and operators through cadavers' studies. Studies have reported that both CT and C-arm X-ray machineguided placement of sacroiliac screws require repeated fluoroscopy, but CT further improved the accuracy of screw position 40 .…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

Long

Gao³

et al. 2019

Orthopaedic Surgery

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Objectives To analyze the curative effect of TiRobot surgical robotic navigation and location system‐assisted percutaneous sacroiliac screw fixation and percutaneous sacroiliac screw by traditional fluoroscopy, and to summarize the safety and benefits of TiRobot. Methods A total of 91 patients with pelvic posterior ring fractures from December 2015 to February 2018 were included in this study. According to the surgical methods selected by the patients, the patients were divided into a TiRobot surgical robotic navigation and location system group (TiRobot group) and a percutaneous sacroiliac screw fixation group (traditional group). Statistical indicators included the number of sacroiliac screws, the time of planning the sacroiliac screw path, fluoroscopy frequency, fluoroscopy time, operation time, length of incision, blood loss, anesthesia time, the healing process of skin incisions, and fracture healing time. Fracture reduction was evaluated according to the maximum displacement degree at the inlet and outlet view X‐ray or CT. Matta standard was used to evaluate fracture reduction. At the last follow‐up, the Majeed function system was used to evaluate the function. Results All patients were followed up for 8 to 32 months. A total of 66 sacroiliac screws were implanted in the TiRobot group. A total of 43 sacroiliac screws were implanted in the traditional group. There were statistically significant differences in terms of fluoroscopy frequency, fluoroscopy time, operation time, incision length, anesthesia time, and blood loss between the two groups; the TiRobot group was superior to the traditional group. The healing time of the TiRobot group and the traditional group was 4.61 ± 0.68 months (range, 3.5–6.3 months) and 4.56 ± 0.78 months (range, 3.4–6.2 months), respectively, and there was no statistical difference. Postoperatively, by Matta standard, the overall excellent and good rate of fracture reduction was 89.28% and 88.57%, respectively. At the last follow‐up, by Majeed function score, the overall excellent and good rate was 91.07% and 91.43%. There was no statistical difference between the two groups. Conclusion Sacroiliac screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures has the characteristics of less trauma, shorter operation time, and less blood loss. TiRobot has the characteristics of high safety and accuracy and has great clinical application value.

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Percutaneous screw fixation of the iliosacral joint: A case-based preoperative planning approach reduces operating time and radiation exposure

Cited by 13 publications

References 47 publications

Comparative study of sacroiliac screw placement guided by 3D-printed template technology and X-ray fluoroscopy

Comparative study of sacroiliac screw placement guided by 3D-printed template technology and X-ray fluoroscopy

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study

Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

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