Felix Karl Ludwig Klingebiel (Zurich / CH), Octavia Klee (Zurich / CH), Yannik Kalbas (Zurich / CH), Michel Paul Johan Teuben (Zurich / CH), Anhua Loong (Beijing / CN), Henrik Teuber (Zurich / CH), Yannis Hoch (Zurich / CH), Valentin Neuhaus (Zurich / CH), Ladislav Mica (Zurich / CH), Hans-Christoph Pape (Zurich / CH), Roman Pfeifer (Zurich / CH)
Abstract text (incl. references and figure legends)
Introduction
Sacroiliac (SI) screw fixation is a feasible treatment option for posterior pelvic ring disruption. During the last decade, navigated screw fixation has been introduced, which provides a three-dimensional vision field for the surgeon. However, this technique requires a more advanced set up. The aim of this study was to compare the outcome of navigated SI-screws with non-navigated SI-screws.
Material&Methods
A retrospective cohort study of patients with acute traumatic pelvic ring injuries at a level one trauma center was performed. Patients aged ≥15, treated with elective SI screw fixation were included. Patients were stratified according to treatment strategy (Group NV: Navigated screws vs. Group CV: conventional screws). Outcome: implant-related complications: breakage, loosening, intraforaminal/malpositioning of the screws, reoperations.
Results
A total of 204 (mean age 61±20 years, mean ISS 17±10) patients were included between 11/2014 and 08/2021. 65 patients (64±21 years) underwent navigated screw fixation, whereas 139 patients (59±20 years) received conventional percutaneous screws to the posterior pelvic ring. Both groups were comparable in terms of age, ISS, and fracture morphology. The navigated group had more severe comorbidities (ASA; NV: 2.92±0.78 vs. CV: 2.54±0.87, p=0.003). Overall hardware complication rates did not differ significantly (p=0.805). However, screw malpositioning only occurred in the CV-group with 6.5%, with 3.6% intraforaminal positioning (vs. NV: 0%). Furthermore, reoperation/implant removal rates after fracture consolidation were lower in the NV-group (NV: 9.2% vs. CV: 21.6%, p=0.05).
Conclusion
Navigated screw fixation of the posterior pelvic ring results in optimal accuracy of screw placement in trauma patients. Patients with severe comorbidities as well as difficult osseous corridors might benefit from a navigated intervention. Future studies should focus on patient selection criteria for navigated procedures.
References
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