• Lars Grossterlinden, Jakob Nuechtern, Philipp G C Begemann, Ina Fuhrhop, Jan P Petersen, Andreas Ruecker, Martin Rupprecht, Wolfgang Lehmann, Udo Schumacher, Johannes M Rueger, and Daniel Briem.
• Department of Trauma, Hand and Reconstructive Surgery, and Institute of Anatomy, University Medical Center Hamburg-Eppendorf, Martinistr 52, D-20246 Hamburg, Germany. lgrosste@uke.de
• J Trauma. 2011 Oct 1;71(4):926-32.

BackgroundThe purpose of this study was to assess the feasibility and accuracy of computer-assisted surgery (CAS) for screw placement in different pelvic regions using intraoperative three-dimensional (3D) imaging and to evaluate the influence of surgeons' experience with such a system on procedure time, radiation time, radiation dose, and misplacement rate.MethodsExperimental study in a human cadaveric model (n=5) for percutaneous screw placement in the anterior column of the acetabulum, the posterior pelvic ring (S1, S2), and the superior pubic ramus via 3D fluoroscopic navigated procedure. Accuracy of screw placement was assessed by 3D image intensifier, including the reconstruction of multiplanar images and by computer tomography (CT) scan. Influence of surgeons' experience was assessed by direct comparison of a low- and high-volume surgeon using the same technical setting.ResultsIn 100% of all procedures, intraoperative Iso-C3D image analysis was sufficient to confirm a correct screw placement. The postoperative CT scan revealed no further screw misplacement. However, for a correct supraacetabular screw placement, the intraoperative 3D scan was essential. In this group, the 3D scan showed screw misplacement in three cases. Procedure time for all indications and screw failure rate were significantly lower for the higher experienced surgeon.ConclusionThe 3D fluoroscopic navigated procedure in pelvic surgery seems to be a useful tool for all surgeons and especially for less experienced ones. Furthermore, the intraoperative reconstruction of multiplanar 3D images allows a secure control of implant positioning.

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