Differences in Accuracy and Radiation Dose in Placement of Iliosacral Screws: Comparison between 3D and 2D Fluoroscopy.

Michał Kułakowski,Aleksandra Królikowska,Karol Elster,Łukasz Oleksy,Jarosław Witkowski,Piotr Morasiewicz,Paweł Ślęczka,Paweł Reichert

doi:10.3390/jcm11061466

Abstract

Percutaneous iliosacral screw fixation is a widely accepted method of stabilizing the posterior pelvic ring. Recently developed tools such as 3D-navigated fluoroscopy and computed navigation seem to prevent a surgeon from conducting screw misplacement. The study aimed to comparatively assess the introduction of sacroiliac screw placement using 2D and 3D fluoroscopy in terms of accuracy and radiation exposure. Iliosacral screws were introduced in 37 patients using 2D (group N1) and in 36 patients using 3D fluoroscopy (group N2) techniques. Overall, 61 and 56 screws were introduced in groups N1 and N2, respectively. Screw placement accuracy was assessed using postoperative computed tomography and Smith’s scale. Intraoperative radiation exposure was also assessed. No differences were noted between groups in terms of screw positioning accuracy and radiation dose. Both 2D and 3D fluoroscopy provide good visualization for safely placing percutaneous iliosacral joint screws. Using 3D fluoroscopy-based navigation in comparison with 2D fluoroscopy is not advantageous.

Highlights

The aim of this study was to compare the accuracy of screw placement and radiation exposures using 2D and 3D fluoroscopy
In the case of 37 patients, they were operated on using 2D fluoroscopy (Ziehm Vision R, Nuremberg, Germany), and 36 were operated on using 3D fluoroscopy (Ziehm Vision FD Vario 3D, Nuremberg, Germany)
All authors have read and agreed to the published version of the manuscript

Summary

Introduction

Pelvic fractures show two peak incidences in general. The first peak is around18–35 years and most cases result from high-energy trauma. Pelvic fractures show two peak incidences in general. 18–35 years and most cases result from high-energy trauma. The second peak is observed in the female population over 70 years old and is strictly related to bone quality [1]. The mortality varies from 7.9% to 10% when ‘the complex pelvic trauma’ definition is fulfilled. We are dealing with a 20% mortality rate when unstable circulation is added [2]. Iliosacral percutaneous screw fixation is a frequently used, minimally invasive method of treatment of posterior pelvic ring injuries [3]. Indications for this technique include iliosacral joint dislocation, sacral fractures, and crescent fractures. Iliosacral screws have multiple advantages, including good biomechanical stability [1]. The use of intraosseous fixation avoids surface contamination as well as implant prominence and skin breakdown [4]

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