Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room |
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| Affiliation: | 1. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital. HTRG - Heidelberg Trauma Research Group, Heidelberg, D-69118 Germany;2. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, D-69118 Germany;3. Theresienkrankenhaus und St. Hedwigs-Klinik GmbH, Department for Trauma Surgery, Mannheim, D-68165 Germany;4. BG Trauma Center Ludwigshafen, Ludwigshafen, D-67071 Germany;1. North Bristol NHS Trust, Bristol, United Kingdom;2. Stryker R&D Virtual Engineering, Kiel, Germany;1. Department of Surgery, Calgary, Alberta, Canada;2. Department of Radiology, Calgary, Alberta, Canada;3. Department of Critical Care Medicine, Calgary, Alberta, Canada;4. Department of Regional Trauma Services, Calgary, Alberta, Canada;5. Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada;6. Alberta Health Services, Alberta, Canada;7. Dialog Corporation, Calgary, Alberta, Canada;8. The University of Texas Health Science Center at Houston, Houston, TX, USA;1. Department of Traumatology, Orthopaedics and Sport Injury, Evangelisches Krankenhaus, Campus University of Oldenburg, Steinweg 13-17, 26123 Oldenburg, Germany;2. Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany;3. Department of Clinical Radiology, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany |
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| Abstract: | IntroductionIn recent years hybrid operating rooms were established all over the world. In our setting we combined a 3D flat-panel c-arm (Artis zeego, Siemens) with a navigation system (BrainLab curve, BrainLab). This worldwide unique combination enables the surgeon to visualise an entire pelvis in CT-like image quality with a single 3D-scan. The aim of our study was to investigate, if utilisation of a hybrid operating room increases the accuracy of SI-screws in comparison to standard 3D-navigation.Material and methodsRetrospective, not randomised single centre case series at a level I trauma centre. Inclusion criterion was insertion of a percutaneous iliosacral screw using image-guidance in the hybrid operating room. 61 patients (35 female, 26 male) were included from June 2012 till October 2014. 65 iliosacral screws were inserted. Intraoperative 3D-scans and postoperative scans were examined to investigate screw placement. The results were compared to a preceding study performed in 2012 using conventional 3D-navigation. Statistical calculations were performed with Microsoft Excel 2011 and SPSS.Results65 iliosacral screws were implanted. Two different types of screws were implanted: 1. “Standard” iliosacral screws stabilizing one joint/a unilateral fracture. 2. Single SI-screws stabilizing both SI-joints and if present a bilateral fracture. Forty one patients were included in group 1 (screws n = 45). There was no perforation in 43 screws, grade 1 perforation in 2 screws. There was no grade 2 or 3 perforation in this group. Compared to the conventional 3D-navigated screws there was a highly significant difference (p < 0.001). Twenty patients could be included in group 2. Eleven screws showed a complete intraosseous position. There was grade 1 perforation in 2 screws, grade 2 perforation in 5 screws and grade 3 perforation in 2 screws.ConclusionImprovements in image quality and enlargement of the display window lead to better intraoperative visualisation of the entire dorsal pelvis. Thereby the accuracy of computer-assisted iliosacral screws could be increased using a hybrid operating room. Furthermore difficult tasks like a single screw for both joints can be accomplished. |
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| Keywords: | Iliosacral screw Computer navigation Hybrid-OR Sacral fracture Intraoperative imaging Fracture Pelvis Computer guidance |
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