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Klingebiel FKL, Kalbas Y, Klee O, Long A, Teuben M, Teuber H, Halvachizadeh S, Berk T, Neuhaus V, Pape HC, Pfeifer R. Efficacy and outcomes of rescue screws in unstable pelvic ring injuries - A retrospective matched cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02649-x. [PMID: 39190065 DOI: 10.1007/s00068-024-02649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE The emergency treatment of unstable pelvic ring injuries is still a challenge and requires surgical and anesthesiological resuscitation. Emergency fixation of the unstable pelvic ring with percutaneous sacroiliac (SI) screws, also known as "Rescue Screws", is an established treatment method. The aim of our study was to compare the outcome and complication rates of "Rescue Screws" with elective SI-screw fixations. METHODS A 1:1 ratio nearest-neighbor matched, retrospective cohort study of trauma patients with acute pelvic ring injuries at a level one trauma center was performed. Patients ≥ 15 years, treated with SI-screw fixation were included. EXCLUSION CRITERIA pathologic fractures, missing consent and navigated procedures. The primary outcome parameters was defined as SI-screw revision operations. Patients were stratified according to treatment strategy (RS: Rescue Screws; EL: elective SI-screws). RESULTS From 392 patients identified between 11/2014 and 08/2021, 186 met the inclusion criteria with 41 in the RS Group and 145 in the EL group. After matching, 41 patients were included in each group with similar baseline characteristics except persistent hemodynamic shock (RS: n = 22 (53.37%) vs. EL: n = 1 (4.3%), p < 0.001). Surgical characteristics were comparable in terms of instrumentation levels and insertion-sites. No significant differences were observed in the outcome parameters (revisions, reoperations, implant-associated complications, LOS and mortality) between both groups. CONCLUSION Treatment of unstable pelvic ring fractures with Rescue Screws appears as a feasible treatment option for emergency stabilization. Rescue Screws are not associated with elevated revision rates and increased complications rates. This minimally invasive technique enables safe emergency stabilization of the posterior pelvic ring. Prospective or randomized clinical trials are required to directly compare Rescue Screws with other competing emergency stabilization techniques.
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Affiliation(s)
- Felix Karl-Ludwig Klingebiel
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland.
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland.
| | - Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Octavia Klee
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Anhua Long
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Michel Teuben
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Henrik Teuber
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Till Berk
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Neuhaus
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
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Mudawi A, Alzobi O, Derbas JN, Ahmed G, Abousamhadaneh M. Optimizing percutaneous reduction and fixation with guidewire modification in pelvic and acetabular fractures: surgical technique and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2107-2112. [PMID: 38548873 PMCID: PMC11101512 DOI: 10.1007/s00590-024-03905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/07/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Minimally invasive percutaneous screw fixation for pelvic ring and acetabular fractures has become increasingly popular due to its numerous benefits. However, the precise placement of the screw remains a critical challenge, necessitating a modification of the current techniques. This paper introduces a refined technique employing a modified guidewire to enhance the precision and efficiency of percutaneous fixation in pelvic and acetabular fractures. METHODS This study details the surgical techniques implemented for correcting guidewire misdirection in percutaneous screw fixation and includes a retrospective analysis of patients treated with this modified approach over a three-year period. RESULTS In this study, 25 patients with pelvic ring and acetabular fractures underwent percutaneous screw fixation. The cohort, predominantly male (23 out of 25), had an average age of 38 years. The majority of injuries were due to traffic accidents (18 out of 25). Types of injuries included pelvic ring (6 cases), acetabular fractures (8 cases), and combined injuries (11 cases). Various screw types, including antegrade and retrograde anterior column screws, retrograde posterior column screws, and lateral compression screws, were used, tailored to each case. Over an average follow-up of 18 months, there were no additional procedures or complications, such as neurovascular injury or hardware failure, indicating successful outcomes in all cases. CONCLUSIONS This study introduces a simple yet effective method to address guidewire misdirection during percutaneous fixation for pelvic and acetabular fractures, offering enhanced precision and potentially better patient outcomes. Further research with a larger patient cohort is required for a more comprehensive understanding of its efficacy compared to traditional methods. LEVEL OF EVIDENCE IV. Therapeutic Study (Surgical technique and Cases-series).
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Affiliation(s)
- Aiman Mudawi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Jawad Nouraldeen Derbas
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Maamoun Abousamhadaneh
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Ansari M, P V V, Kesharwani AK, Damkondwar SS, Kakade RU. A Comparative Study of Functional Outcomes in Unstable Pelvic Ring Fractures Treated With Internal Fixator (INFIX) With and Without Sacroiliac Joint Screw Fixation. Cureus 2024; 16:e60279. [PMID: 38872681 PMCID: PMC11170225 DOI: 10.7759/cureus.60279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Despite constituting only 3-8% of orthopedic trauma cases, pelvic injuries are associated with high mortality rates, emphasizing the critical need for stable fixation rather than merely anatomical alignment. The use of an anterior, subcutaneous, internal pelvic fixator (INFIX), a novel technique, has shown promise in treating these injuries. Posterior pelvic ring injuries are challenging because they require a significant level of surgical training and technical expertise, and each treatment method has disadvantages. The aim of this study is to compare the clinical and biomechanical outcomes of INFIX with and without sacroiliac screw fixation for unstable pelvic fractures. Methods and methodology Retrospectively, we selected 20 patients with unstable pelvic ring injuries who had come to a high-volume tertiary care hospital and medical college in the state of Maharashtra, India. All the patients were operated on with INFIX; 10 with a sacroiliac joint screw and 10 without a sacroiliac joint screw. We followed up with the patients for six months and evaluated them according to the Majeed score. Results Functional outcomes differed little between INFIX patients operated on with and without a sacroiliac joint screw. However, morbidity, hospital stay, the need for ICU, radiation exposure, and technical ease of surgery were improved in INFIX patients without the sacroiliac screw procedure. We noted an average Majeed score of 78 in the INFIX-alone group and 77.2 in the group that received INFIX with a sacroiliac joint screw. Six months after the surgery, the patients showed signs of a stable bony union, had achieved a full range of motion, and reported no problems in their day-to-day work. Conclusion Although this was a short-term study, we conclude that INFIX without a sacroiliac joint screw showed a comparable functional outcome compared to INFIX with a sacroiliac joint screw. Patients with INFIX alone showed better results; they had reduced surgical time, reduced radiation exposure, and less evidence of neurological harm to the L5-S1 nerve root. The procedure was less complicated and easier for surgeons to learn. Its simplicity and speed were especially beneficial for obese patients.
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Affiliation(s)
- Muqtadeer Ansari
- Department of Orthopedics, Government Medical College Aurangabad, Aurangabad, IND
| | - Vimal P V
- Department of Orthopedics, Government Medical College Aurangabad, Aurangabad, IND
| | - Arpit K Kesharwani
- Department of Orthopedics, Government Medical College Aurangabad, Aurangabad, IND
| | - Saurabh S Damkondwar
- Department of Orthopedics, Government Medical College Aurangabad, Aurangabad, IND
| | - Rohan U Kakade
- Department of Orthopedics, Government Medical College Aurangabad, Aurangabad, IND
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Andrés-Peiró JV, Piedra-Calle CA, Blasco-Casado F, García-Albó E, Tomàs-Hernández J, Selga-Marsà J, García-Sánchez Y, de Albert de Delás-Vigo M, Teixidor-Serra J. [Translated article] Insertion of S1 iliosacral screws in the computed tomography room: An alternative to improve safety in the percutaneous management of posterior pelvic ring injuries. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T253-T261. [PMID: 38232932 DOI: 10.1016/j.recot.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/09/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.
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Affiliation(s)
- J V Andrés-Peiró
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - C A Piedra-Calle
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - F Blasco-Casado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E García-Albó
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Tomàs-Hernández
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - J Selga-Marsà
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Y García-Sánchez
- Departamento de Radiología Musculoesquelética, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M de Albert de Delás-Vigo
- Departamento de Radiología Musculoesquelética, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Teixidor-Serra
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Andrés-Peiró JV, Piedra-Calle CA, Blasco-Casado F, García-Albó E, Tomàs-Hernández J, Selga-Marsà J, García-Sánchez Y, de Albert de Delás-Vigo M, Teixidor-Serra J. Insertion of S1 iliosacral screws in the computed tomography room: An alternative to improve safety in the percutaneous management of posterior pelvic ring injuries. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:253-261. [PMID: 37918689 DOI: 10.1016/j.recot.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.
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Affiliation(s)
- J V Andrés-Peiró
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España.
| | - C A Piedra-Calle
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - F Blasco-Casado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E García-Albó
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Tomàs-Hernández
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - J Selga-Marsà
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - Y García-Sánchez
- Departamento de Radiología Musculoesquelética, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M de Albert de Delás-Vigo
- Departamento de Radiología Musculoesquelética, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Teixidor-Serra
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Cirugía Ortopédica y Traumatología, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
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Arbash M, Alzobi OZ, Salameh M, Alkhayarin M, Ahmed G. Incidence, risk factors, and prognosis of sciatic nerve injury in acetabular fractures: a retrospective cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2024; 48:849-856. [PMID: 38195944 PMCID: PMC10902080 DOI: 10.1007/s00264-024-06087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE This study aimed to investigate the incidence, risk factors of the sciatic nerve injury in patients with acetabulum fractures and assess its prognosis. METHODS A retrospective cross-sectional review was conducted on 273 patients with acetabulum fractures who were treated between January 1st, 2017, and December 30th, 2019. The medical records and radiographs of these patients were analyzed. RESULTS The overall nerve injury rate was 7.7% (21 of 273 cases), with 3.1% (8 of 273 cases) occurring because of the initial injury and 12.8% (13 of 101 cases) as post-operative complications. Among those with nerve injuries, 95.2% (20 of 21 cases) were males and the average age of the patients was 31.5 (SD 9.5) years. The most common mechanism of injury was motor vehicle collisions with 55.7% (152 of 273 cases), and the most common fracture pattern associated with nerve injury was posterior column and posterior wall fracture with 31.6% (6 of 21 cases). Hip dislocation was found in 16.5% (14 of 21 cases) of patients with nerve injury. The Kocher Langenbeck approach was the most common approach used for patients with post-operative nerve injury, and the prone position was significantly associated with sciatic nerve injury during the operation. Of all patients with nerve injury, 52% (11 of 21 cases) had fully recovered, 29% (6 of 21 cases) had partially recovered, and 19% (4 of 21 cases) had no improvement. The average follow-up was 15 months. CONCLUSION This study emphasizes the incidence of sciatic nerve injuries in individuals with acetabulum fractures and highlights key risk factors, including hip dislocation, posterior column, and posterior wall fractures. It is noteworthy that the Kocher Langenbeck approach and the prone position may contribute to iatrogenic nerve injuries. Encouragingly, over half of the patients who suffered nerve injuries achieved full recovery, while nearly one-third experienced partial recovery. These findings underscore the vital significance of recognizing and addressing these risk factors in clinical practice.
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Affiliation(s)
- Mahmood Arbash
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Z Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Orthopaedics and Rehabilitation Department, Yale University School of Medicine, New Haven, CT, USA
| | - Mohd Alkhayarin
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Kalbas Y, Hoch Y, Klingebiel FKL, Klee O, Cester D, Halvachizadeh S, Berk T, Wanner GA, Pfeifer R, Pape HC, Hasler RM. 3D-navigation for SI screw fixation - How does it affect radiation exposure for patients and medical personnel? Injury 2024; 55:111214. [PMID: 38029680 DOI: 10.1016/j.injury.2023.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND 3D-navigation for percutaneous sacroiliac (SI) screw fixation is becoming increasingly common and several studies report great advantages of this technology. However, there is still limited clinical evidence on the efficacy regarding radiation exposure for patient and personnel. METHODS This is a retrospective, single-center cohort study. All patients who underwent percutaneous sacroiliac screw fixation for an injury of the posterior pelvic ring from 2014 to 2021 were screened. Inclusion criteria were: conclusive radiation dosage reports, signed informed consent, a twelve month follow up and a complete data set. Patients were stratified in two groups (3D-navigation (Group 3D-N) vs. control (Group F)) based on the imaging modality used. Primary outcomes were radiation exposure for patient and personnel. Secondary outcomes were reoperations, complications, and intraoperative precision. RESULTS Of 392 patients screened, 174 patients (3D-N: n = 50, F: n = 124) could be included for final analysis. We noted a significant reduction of the dose corresponding to potential radiation exposure for medical personnel (-15.3 mGy, 95 %CI: -2.1 to -28.5, p = 0.0232), but also a significant increase of the dose quantifying radiation exposure for patients (+77.0 mGy, 95 %CI: +53.3 to +100.6, p < 0.0001), when using navigation. In addition, the rate of radiographic malplacement was significantly reduced (F: 11.3% vs. 3D-N: 0 %, p = 0.0113) despite a substantial increase in transsacral screw placement (F: 19.4% vs. 3D-N: 76 %). CONCLUSION Our data clearly suggests that the use of 3D-navigation for percutaneous SI screw fixation decreases radiation exposure for medical personnel, while increasing radiation exposure for patients. Furthermore, intraoperative precision is improved, even in more challenging operations.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland.
| | - Yannis Hoch
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Felix Karl-Ludwig Klingebiel
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Octavia Klee
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Davide Cester
- University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Till Berk
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Guido A Wanner
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Center for Spine Surgery and Trauma Surgery, Bethanien Hospital, Toblerstr. 51 8044 Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Rebecca Maria Hasler
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Prodorso Center for Spine Medicine, Walchestr. 15 CH-8006 Zürich, Switzerland
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Elmhiregh A, Hantouly AT, Alzoubi O, George B, Ahmadi M, Ahmed G. The optimal fluoroscopic views to rule out intra-articular screw penetration during acetabular fracture fixation. INTERNATIONAL ORTHOPAEDICS 2024; 48:243-252. [PMID: 37855923 PMCID: PMC10766808 DOI: 10.1007/s00264-023-06002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To determine the ideal view(s) and the minimum number of intraoperative fluoroscopic views required to rule out any intra-articular screw violation in acetabular fractures fixation. METHODS This study was conducted using a series of fluoroscopic examinations of pelvic synthetic models with screws positioned in different planes around the acetabulum. Ten screws were placed in the synthetic pelvis models in different planes of the acetabulum. Seven views were taken for each screw. Radiographic images were evaluated by 14 orthopaedic surgeons who were asked to assess joint violation and the view(s) required for assessment. RESULTS The observers' accuracy rate in identifying joint violation was 82.1% for the anterior part of the anterior column and the superior part of the posterior column, 89.3% for the posterior part of the anterior column and the inferior part of the posterior column, and 92.9% for the quadrilateral plate. The sensitivity was 100% for the anterior and posterior parts of the anterior column and the inferior part of the posterior column, 87.5% for the superior part of the posterior column, and 85.7% for the quadrilateral plate. The specificity was 100% for the quadrilateral plate, 80% for the superior part of the posterior column and the posterior part of the anterior column, 78.6% for the inferior part of the posterior column, and 66.7% for the anterior part of the anterior column. There was a strong overall interobserver and intra-observer agreement with intraclass correlation coefficient (ICC) of 0.709 and 0.86, respectively. CONCLUSIONS This study confirms the hypothesis that in a concave surface/joint fixation, such as the acetabulum, the probability of joint violation is unlikely if there is no evidence of it within a single fluoroscopic view. In acetabulum fracture fixation with a screw violating the joint, the screw's presence was evident within the joint space in all fluoroscopic views. However, the absence of joint violation in one fluoroscopic view was adequate to rule out joint penetration.
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Affiliation(s)
- Aissam Elmhiregh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzoubi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Bivin George
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohsen Ahmadi
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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