An evaluation of three-dimensional image–guided technologies in percutaneous pelvic and acetabular lag screw placement

BackgroundPercutaneous stabilization using three-dimensional (3D) navigation system is a promising treatment for pelvic and acetabular fractures. However, there are still some controversies regarding the use of 3D navigation to treat pelvic and acetabular fractures. The purpose of this study was to compare the Iso-C3D fluoroscopic navigation, standard fluoroscopy, and two-dimensional (2D) fluoroscopic navigation in placing percutaneous lag screws in pelvic specimens to better understand the merits of 3D navigation techniques.MethodsFifty-four instrumentation procedures were performed in this study using six cadaveric pelvic specimens. Three groups were designated for different procedures and tests: group I, standard fluoroscopy; group II, 2D fluoroscopic navigation; and group III, Iso-C3D fluoroscopic navigation. Nine screws were placed in each pelvis, including four screws placed bilaterally through the ilium into S1 and S2 vertebrae, four screws placed bilaterally through anterior and posterior columns of acetabulum, and one screw placed through the pubic symphysis. 3D fluoroscopic techniques were evaluated to determine the accuracy of screw position, instrumentation time, and fluoroscopic time. The data were statistically analyzed using SPSS 13.0.ResultsThe malposition rate was 38.89%, 22.22%, and 0% in standard fluoroscopy, 2D fluoroscopic navigation, and Iso-C3D fluoroscopic navigation groups, respectively. There was no significant difference between standard fluoroscopy and 2D fluoroscopic navigation. Compared with Iso-C3D fluoroscopic navigation, there were significant differences (analysis of variance [ANOVA], P < 0.05). The mean instrumentation operating time using Iso-C3D fluoroscopic navigation technique was 15.4 ± 4.5 min. There were significant differences compared with standard fluoroscopy (31.5 ± 6.2 min) and 2D fluoroscopic navigation (26.3 ± 7.5 min; ANOVA, post hoc Scheffe, P < 0.01). The mean fluoroscopic time of Iso-C3D fluoroscopic navigation was 66 ± 4.8 min. Compared with standard fluoroscopy (132.8 ± 7.3 min) and 2D fluoroscopic navigation (47.7 ± 5.6 min), there were significant differences (ANOVA, post hoc least significant difference, P < 0.01).ConclusionsIn the present study, we compared Iso-C3D fluoroscopic navigation, 2D fluoroscopic navigation, and standard fluoroscopy. Iso-C3D fluoroscopic navigation showed a higher accuracy rate in positioning and a shorter instrumentation operating time. The fluoroscopic time was longer in Iso-C3D fluoroscopic navigation than that in standard fluoroscopy, indicating that radiation exposure can be moderately reduced in Iso-C3D fluoroscopic navigation operation, although the fluoroscopic time was the shortest in 2D fluoroscopic navigation.