Skip to main content
SpringerLink
Log in

Comparison of 3D C-arm fluoroscopy and 3D image-guided navigation for minimally invasive pelvic surgery

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aims to compare the efficacy and accuracy of percutaneous screw fixation using three-dimensional \((\hbox {ISO-C}^\mathrm{3D})\) navigation and conventional C-arm fluoroscopy in pelvic fracture surgery.

Methods

This was a retrospective study of 81 patients with pelvic fractures treated using percutaneous screw fixation between June 2005 and January 2011. All pelvic fractures were treated with closed reduction, small open reduction, or medium open reduction. Intraoperative radiation exposure, fixation, surgical outcome, and functional recovery were compared based on the fluoroscopy navigation method used during screw fixation. Radiographic follow-up was assessed at 1, 3, 6, and 9 months postoperatively, and a CT scan was completed at 9 months postoperatively.

Results

A total of 130 cannulated screws were placed. Average screw fixation time and fluoroscopy exposure time in \(\hbox {ISO-C}^\mathrm{3D}\) group were lower than the C-arm fluoroscopy group (\(4.0\,\pm \,0.7\,\hbox {min};\, 34.2\,\pm \,2.2\,\hbox {s}\) vs \(19.4\,\pm \,0.8\,\hbox {min};\, 57.8\,\pm \,4.9\,\hbox {s}\)) \((P<0.001)\). Seventy-four of the 81 patients made a full recovery. Successful outcome was confirmed with radiological imaging and postoperative follow-up at 6–24 months. No delayed union or nonunion was detected. No significant difference in functional recovery at 6 months postoperative was found due to the fluoroscopy imaging technique.

Conclusions

Percutaneous screw fixation using the \(\hbox {ISO-C}^\mathrm{3D}\) navigational system minimizes the fluoroscope exposure and screw insertion time, while improving screw insertion accuracy. Moreover, the \(\hbox {ISO-C}^\mathrm{3D}\) navigational system provided a reliable method for fluoroscopy imaging in pelvic fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Petrisor BA, Bhandari M (2005) Injury to the pelvic ring: incidence, classification, associated injuries and mortality rates. Curr Orthop 19:327–333

    Article  Google Scholar 

  2. McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC (2010) Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis 68:281–291

    PubMed  Google Scholar 

  3. Matta J, Tornetta PI (1996) Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 329:129–140

    Article  PubMed  Google Scholar 

  4. Wong J-L, Bucknill A (2013) Fractures of the pelvic ring. Injury. doi:10.1016/j.injury.2013.11.021

    Google Scholar 

  5. van Vugt AB, van Kampen A (2006) An unstable pelvic ring. J Bone Jt Surg(Br) 88–B:427–433

  6. Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV (2009) Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop 33:329–338

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Shuler TE, Boone DC, Gruen GS, Peitzman AB (1995) Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma 38:453–458

    Article  CAS  PubMed  Google Scholar 

  8. Guo XS, Chi YL (2006) Percutaneous fixation of pelvic ring disruptions. Zhonghua Wai Ke Za Zhi 44(4):260–263

    PubMed  Google Scholar 

  9. Mosheiff R, Khoury A, Weil Y, Liebergall M (2004) First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma 18(2):106–111

    Article  PubMed  Google Scholar 

  10. Stöckle U, Schaser K, König B (2007) Image guidance in pelvic and acetabular surgery—expectations, success and limitations. Injury 38:450–462

    Article  PubMed  Google Scholar 

  11. Tile M (1995) Classification. In: Tile M (ed) Fracture of the pelvis and acetabulum, 2nd edn. Williams & Wilkins, Baltimore, pp 66–101

    Google Scholar 

  12. Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  CAS  PubMed  Google Scholar 

  13. Matta JM (1996) Fracture of the acetabulum:accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Jt Surg (Am) 78:1632–1645

    CAS  Google Scholar 

  14. Smith HE, Yuan PS, Sasso R, Papadopolous S, Vaccaro AR (2006) An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine 31:234–238

    Article  PubMed  Google Scholar 

  15. Majeed SA (1989) Grading the outcome of pelvic fracture. J Bone Jt Surg (Br) 71:304–306

    CAS  Google Scholar 

  16. Kabak S, Halici M, Tuncel M, Avsarogullari L, Baktir A, Basturk M (2003) Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J Orthop Trauma 17(8):555–562

    Article  PubMed  Google Scholar 

  17. Kellam JF, McMurtry RY, Paley D, Tile M (1987) The unstable pelvic facture. Operative treatment. Orthop Clin North Am 18(1):25–41

    CAS  PubMed  Google Scholar 

  18. Rommens PM (2007) Is there a role for percutaneous pelvic and acetabular reconstruction? Injury 38:463–477

    Article  CAS  PubMed  Google Scholar 

  19. Mosheiff R, Khoury A, Weil Y, Liebergall M (2004) First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma 18:106–111

    Article  PubMed  Google Scholar 

  20. Amiot LP, Lang K, Putzier M, Zippel H, Labelle H (2000) Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine 25:606–614

    Article  CAS  PubMed  Google Scholar 

  21. Giannoudis PV, Papadokostakis G, Alpantaki K, Kontakis G, Chalidis B (2008) Is the lateral sacral fluoroscopic view essential for accurate percutaneous sacroiliac screw insertion? An experimental study. Injury 39:875–880

    Article  CAS  PubMed  Google Scholar 

  22. Zwingmann J, Konrad G, Kotter E, Südkamp NP, Oberst M (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 467:1833–1838

    Article  PubMed Central  PubMed  Google Scholar 

  23. Schep NW, Haverlag R, van Vugt AB (2004) Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain. J Trauma 57(6):1299–1302

    Article  PubMed  Google Scholar 

  24. Collinge C, Coons D, Tornetta P, Aschenbrenner J (2005) Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model. J Orthop Trauma 19(4):254–258

    Article  PubMed  Google Scholar 

  25. Ochs BG, Gonser C, Shiozawa T, Badke A, Weise K, Rolauffs B, Stuby FM (2010) Computer-assisted periacetabular screw placement: comparison of different fluoroscopy-based navigation procedures with conventional technique. Injury 41:1297–1305

    Article  PubMed  Google Scholar 

  26. Behrendt D, Mütze M, Steinke H, Koestler M, Josten C, Böhme J (2012) Evaluation of 2D and 3D navigation for iliosacral screw fixation. Int J Comput Assist Radiol Surg 7:249–255

    Article  PubMed  Google Scholar 

  27. Hinsche AF, Giannoudis PV, Smith RM (2002) Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res 395:135–144

    Article  PubMed  Google Scholar 

  28. Amiot LP, Lang K, Putzier M, Zippel H, Labelle H (2000) Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine 25(5):606–614

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China

      Bin Li, Jiliang He, Dongsheng Zhou, Zhenhai Hao, Yonghui Wang & Qinghu Li

    2. Department of Orthopaedics, General Hospital of the Second Artillery, Beijing, 100088, China

      Zexing Zhu

    Authors
    1. Bin Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jiliang He
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Zexing Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Dongsheng Zhou
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Zhenhai Hao
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Yonghui Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Qinghu Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Zhenhai Hao.

    Additional information

    Bin Li and Jiliang He contributed equally to this work as the co-first authors.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Li, B., He, J., Zhu, Z. et al. Comparison of 3D C-arm fluoroscopy and 3D image-guided navigation for minimally invasive pelvic surgery. Int J CARS 10, 1527–1534 (2015). https://doi.org/10.1007/s11548-015-1157-6

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11548-015-1157-6

    Keywords

    Search

    Navigation