Percutaneous screwing for unstable pelvic fractures with fluoroscopy-bused computerized navigation

Abstract

Objective To discuss operative indications and clinical outcomes of the fluo-roscopy-based computerized navigational system for unstable pelvic fractures. Methods From August 2006 to September 2008, 16 patients with unstable pelvic fractures were treated with pereutaneous screwing under a fluoroscopy-based computer navigation system. According to Tile classification, 2 cases were type B2,3 type B3, 8 type C2, and 3 type C3. Navigated pereutaneons screwing included 26 sacroiliac screws in 14 eases, 15 superior ramus medullary screws in 9 cases, 4 pubic symphysis screws in 4 cases, and 2 anterior column screws in 2 cases. Accuracy of screw placement was verified by radiography and CT scan. Mean time of percutaneous screw implantation and intra-operative fluoroscopic time were recorded for each type to evaluate the procedure. Results Eleven patients were followed up for 119.6 ± 2.3 d. The mean time of bone healing was 67.7 ± 9.7 d. All screws were placed accurately without perforating the cortex. Expect a little numbness in the lower extremities in 3 patients, no eomplication was noted postoperatively. The mean time of navigated screw implantation was 26. 39 ± 6. 23 min for sacroiliac screw, 18.20 ± 1.59 min for superior ramus medullary screw, 13.70 ± 2.13 min for pubic symphysis screw implantation, and 19.40 ± 0.79 min for an-terior column screw. The mean time of intra-operative fluoroscopy was 0. 57 ± 0. 03 min for sacroiliac screw,0.61±0.13 min for superior ramus medullary screw, 0.33±0.06 min for pubic symphysis screw, and 0.63 ± 0.02 min for anterior column screw. Conclusions Percutaneous sacroiliac screwing, superior ramus medullary screwing, pubic symphysis screwing can be performed with assistance of fluoroscopy-based computerized navigation for the treatment of unstable peivie fractures. Though the indications for this procedure are limited, we think it should be applied due to its advantages of less radiation, higher accuracy and greater reliability. Key words: Pelvis; Fractures; Surgery, computer-assisted; Fracture fixation, internal