Precise sacroiliac joint screw insertion without computed tomography, digital volume tomography or navigation systems

• Published in: Operative Orthopädie und Traumatologie Vol. 31; no. 6; pp. 474 - 490
• Main Authors: Roetman, B, Ilchuk, I, Khatib, B, Goerigk, U, Gothner, M
• Format: Journal Article
• Language: German
• Published: Germany 01-12-2019
• Subjects: Bone Screws; Cone-Beam Computed Tomography; Fracture Fixation, Internal; Fractures, Bone - surgery; Humans; Ilium; Sacroiliac Joint - diagnostic imaging; Sacroiliac Joint - surgery; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome; Bone screws; Diagnostic imaging; Fluoroscopy; Preoperative procedures; Malposition
• ISSN: 1439-0981
• DOI: 10.1007/s00064-019-0607-7

Improvement of sacroiliac positioning of screws by detailed preoperative planning with a DICOM (Digital Imaging and Communications in Medicine-the international standard to store and process medical imaging information) workstation in the absence of advanced technical facilities like intraoperative computer tomography (CT), digital volume tomography (DVT) or a navigation system.
Mono- or bilateral non- or minor displaced, longitudinal sacral fractures type Denis I and II and pelvic ring fractures (Orthopedic Trauma Association) OTA type B possibly in combination with a ventral procedure.
Displaced sacral fractures type Denis II and III, fractures with central comminution and circulatory unstable patients to be stabilized in the context of emergency care.
Preoperative calculation of virtual conventional standard view X‑rays with the CT dataset using common DICOM software (e.g., Siemens via® or Sectra®). Typical landmarks such as screw entry point and end point are projected into the virtual X‑rays. Intraoperative navigation is performed by comparing the virtual standard views with fluoroscopic images of the C‑arm, thereby, simplifying the operative procedure.
Postoperative CT scan, pain adapted partial weight bearing and X‑rays of the pelvic ring after 6 and 12 weeks.
Over a 13 month period, an orthopedic surgeon inserted 26 sacroiliac screws in 19 patients utilizing the described method. Postoperative CT scans revealed that all except three screws were precisely positioned without any bone perforation. Of these three screws one had a grade one perforation and two had a grade two perforation according to Smith. No revision was necessary and no neurological deficits were detected. The operating time was on average 33 min and duration of radiation 3.8 min.