Accuracy of 3D-navigated screw fixation in pelvic ring fractures: a single-centre consecutive observational case series

Abstract Purpose 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 accuracy of 3D navigation in percutaneous screw fixation of pelvic ring fractures. Methods A consecutive case series including all patients undergoing 3D-guided screw fixation of pelvic ring fractures between 2019 and 2022 was conducted. Primary study endpoints were screw misplacement, neurological complications, and surgical site infections. Data were 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%), screw misplacements were observed. No neurological complications occurred due to screw misplacement. Conclusions The result of the current study shows that 3D navigation provides excellent screw placement accuracy, with minimal screw misplacements and no neurological complications due to screw misplacement.