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  • Title: Effects of three-dimensional navigation on intraoperative management and early postoperative outcome after open reduction and internal fixation of displaced acetabular fractures.
    Author: Oberst M, Hauschild O, Konstantinidis L, Suedkamp NP, Schmal H.
    Journal: J Trauma Acute Care Surg; 2012 Oct; 73(4):950-6. PubMed ID: 22710769.
    Abstract:
    BACKGROUND: This study was conducted to evaluate whether intraoperative procedure and/or early postoperative results after open reduction and internal fixation (ORIF) of displaced acetabulum fractures are influenced by the use of a three-dimensional (3D) image intensifier in combination with a navigation system. METHODS: From January 2004 until December 2008, all patients with acetabular fractures were followed prospectively. From January 2004 until October 2006, all operations were performed under fluoroscopic control using a conventional two-dimensional image intensifier. Since October 2006, we regularly operate acetabular fractures with the intraoperative use of a navigation system and a 3D image intensifier. Pre- and postoperative computed tomography scans of the affected hip were obtained in all patients as were standard anterior-posterior radiographs and ala- and obturator views. All data collection was performed according to the guidelines of the "German Pelvic fracture study group." RESULTS: In total, 68 patients with acetabular fractures were included in the study. A conventional image intensifier was used in 37 patients (group A) and a 3D image-based navigation was used in the remaining 31 patients (group B). In the navigated group, seven patients were assessed incapable of partial weight bearing. These patients underwent computer-assisted percutaneous screwing of their acetabular fracture. Using a navigation system in combination with a 3D image intensifier for ORIF of displaced acetabular fractures led to a significant increase in skin-to-skin time. Postoperative radiolographic analysis revealed an improvement in the quality of fracture reduction in the 3D navigation group. Navigation in combination with the 3D images of the ISO-C 3D limited the need for extended approaches. In addition, the complication rate in the navigated group was significantly lower. CONCLUSION: We support the use of navigation systems and a 3D image intensifier as helpful tools during ORIF of displaced acetabular fractures. LEVEL OF EVIDENCE: Therapeutic study, level III.
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