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  • Title: Multidimensional Pelvic Fluoroscopy: A New and Novel Technique for Assessing Safety and Accuracy of Percutaneous Iliosacral Screw Fixation.
    Author: Shaw J, Gary J, Ambrose C, Routt MC.
    Journal: J Orthop Trauma; 2020 Nov; 34(11):572-577. PubMed ID: 33065656.
    Abstract:
    OBJECTIVES: Multidimensional fluoroscopy is new imaging technology that generates intraoperative cross sectional imaging. Can this technology be used to assess accuracy and safety of percutaneously placed iliosacral screws intraoperatively? DESIGN: Retrospective study. SETTING: Level 1 academic trauma center. PATIENTS/PARTICIPANTS: Fifty-two consecutive patients during a 7-month period with unstable posterior pelvic ring disruptions. INTERVENTION: All patients were treated with percutaneous iliosacral and/or transsacral screw fixation by a single experienced surgeon. Traditional triplanar fluoroscopy was performed during guidepin insertion. Intraoperative multidimensional fluoroscopy was used for all patients after iliosacral screw fixation. MAIN OUTCOME MEASUREMENTS: Intraoperative multidimensional fluoroscopy and postoperative computed tomography (CT) scans for each patient were retrospectively reviewed by the treating surgeon and another trauma surgeon. Screw position in relation to the sacral neuroforamen was assessed using multidimensional fluoroscopy and compared to postoperative CT scan. Screws were classified as extraforaminal, juxtaforaminal, or intraforaminal. RESULTS: No screws were intraforaminally seen on intraoperative multidimensional fluoroscopy or postoperative CT scan. All iliosacral and transsacral screws were considered safe. Intraobserver and interobserver variability existed between reviewers when grading screws as extraforaminal versus juxtaforaminal. This was not clinically significant because both agreed that extraforaminal and juxtaforaminal screw positions are safe. Multidimensional fluoroscopy was used in 3 patients to assess guidepin placement before definitive screw fixation. Two patients underwent a change of fixation after reviewing multidimensional fluoroscopy. No postoperative neurological examination changes occurred. CONCLUSIONS: Multidimensional fluoroscopy is a novel imaging technology that can safely be used intraoperatively to accurately determine iliosacral and transsacral screw placement. LEVELS OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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