Safety of 3D image-guided navigated screw placement in pelvic ring fractures: A consecutive case series.

Abstract Background Conventional 2D fluoroscopy-based screw fixation of pelvic ring fractures has high screw misplacement rates and can be technically challenging. Implementation of 3D image-guidance is presumed to simplify screw placement and improve procedural safety. The objective of this study was to evaluate the safety of 3D image-guided navigation in screw fixation of pelvic ring fractures. Methods A consecutive case series including all patients undergoing 3D CT-guided screw fixation of pelvic ring fractures between 2019–2022 was conducted. Primary study endpoints were screw misplacement, neurological complications and surgical site infections. Data was analysed using descriptive statistics. Results A total of 90 consecutive patients (180 screws) were included, with 120 transsacral- transiliac screws (TSTI) and 60 sacral-iliac (SI) screws used for posterior fixation, 5 retrograde transpubic screws placed for anterior fixation, and 23 antegrade screws placed into the superior rami. For two patients (2.7%) post-operative cannulated screw misplacements were observed, and one neurological complication due to screw misplacement occurred. Conclusions The result of the current study shows that 3D-image CT-guided navigation provides excellent safety, with minimal screw misplacements and minimal neurological complications due to screw misplacement. Trial registration: retrospectively registered