ObjectiveThe goal of this study was to analyze our initial experience using a novel porous fusion/fixation screw (PFFS) for pelvic fixation, and to determine our rate of screw malposition requiring intraoperative repositioning. MethodsWe reviewed 83 consecutive patients who underwent sacropelvic fixation with PFFS at our institution from 6/1/2022-6/30/2023 using intraoperative CT-based computer-assisted navigation (CAN) via an open posterior approach. Following PFFS insertion, intraoperative CT scans were obtained to assess screw positioning. Demographic data was collected, and operative reports and patient images were reviewed to determine what implants were used and if any PFFS required repositioning. Results74 patients (26M:48F) were included, and 57 (77.0%) had a prior sacroiliac joint or lumbar spine surgery. A stacked screw configuration was used in 62/74 cases (83.8%). A total of 235 PFFS were used and six (2.6%) were malpositioned. Of 88 cephalic screws placed in stacked configuration, 4 were malpositioned (4.5%); and 1/123 caudal screws were malpositioned (0.8%). One of 24 SAI screws placed in a stand-alone configuration was malpositioned (4.2%). Malpositions included four medial, one lateral, and one inferior; and all were revised intraoperatively without major sequela. ConclusionsAlthough PFFS are larger than traditional sacropelvic fixation screws, stacked SAI instrumentation can be done safely with CAN. We found a low malposition rate in our initial series of patients, the majority being the cephalad screw in a stacked configuration. This isn’t surprising, as these are placed after the caudal screws which reduces the available corridor size and increases the placement difficulty.