Posterior pelvic ring fractures: Intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws

Introduction: Posterior pelvic ring fractures frequently pose a problem of stability with an elevated risk of complications. The traditional method of percutaneous sacroiliac (SI) stabilization with the use of fluoroscopic image amplifiers demands a high degree of experience and has an elevated risk of screws' malpositioning. Hypothesis: Intraoperative 3D-CT scan coupled with a navigation system (OArm(C)) can allow screw fixation accuracy while limiting the risk of complications for the treatment of posterior pelvic ring fractures. Material and methods: Patients with posterior pelvic ring fractures stabilized with percutaneous SI screws through O-Arm(C) navigation from August 2008 to December 2017 were analyzed. A modified Gras classification was used to determine screws' positioning under CT visualization, and intraoperative and early postoperative complications were documented. Results: Among the 21 patients evaluated, 14 men and 7 women with a mean age of 57.8 years (range 25-91), receiving 39 screws, the rate of misplacement was low: 82% grade I, 15.4% grade II, and only 2.6% grade III. Only one patient underwent revision surgery, not because of misplacement but rather for a secondary implant loosening. No complications occurred in this series. Discussion: This study documented a large series of patients treated for pelvic ring fractures using the intraoperative 3D-CT O-Arm(C) guided navigation. This surgical approach provided a precise and safe SI screw positioning with no complications. (C) 2018 Published by Elsevier Masson SAS.