Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room
Abstract Background The prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-12-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-022-06026-w |
| _version_ | 1828123318350249984 |
|---|---|
| author | Mika Takaesu Satoshi Nakasone Yoshihide Miyata Kotaro Nishida |
| author_facet | Mika Takaesu Satoshi Nakasone Yoshihide Miyata Kotaro Nishida |
| author_sort | Mika Takaesu |
| collection | DOAJ |
| description | Abstract Background The prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of blood vessels and neuroforamina. Hence, this study aimed to investigate the accuracy and clinical outcomes of PPSP using real-time 3D fluoroscopic navigation for FFP in the hybrid operating room. Methods This study included 41 patients with FFP who underwent PPSP in a hybrid operating room between April 2016 and December 2020. Intraoperative C-arm cone-beam CT was performed under general anesthesia. Guidewire trajectory was planned using a needle guidance system. The guidewire was inserted along the overlaid trajectory using 3D fluoroscopic navigation, and a 6.5 mm cannulated cancellous screw (CCS) was placed. The clinical outcomes and accuracy of the screw placement were then investigated. Results A total of 121 screws were placed. The mean operative time was 84 ± 38.7 minutes, and the mean blood loss was 7.6 ± 3.8 g. The mean time to wheelchair transfer was 2 days postoperatively. Pain was relieved in 35 patients. Gait ability from preoperative and latest follow-up after surgery was maintained in 30 (73%) patients. All 41 patients achieved bone union. Of the 121 screws, 119 were grade 0 with no misplacement; only 2 patients had grade 1 perforations. Conclusion PPSP using real-time 3D fluoroscopic navigation in a hybrid operating room was accurate and useful for early mobilization and pain relief among older patients with FFP with an already-installed needle biopsy application. |
| first_indexed | 2024-04-11T14:49:51Z |
| format | Article |
| id | doaj.art-1f3cdc94c01a4453839ffdc4ae1dbac7 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T14:49:51Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-1f3cdc94c01a4453839ffdc4ae1dbac72022-12-22T04:17:32ZengBMCBMC Musculoskeletal Disorders1471-24742022-12-012311810.1186/s12891-022-06026-wReal-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating roomMika Takaesu0Satoshi Nakasone1Yoshihide Miyata2Kotaro Nishida3Department of Orthopaedic Surgery, Chubu Tokushukai HospitalDepartment of Orthopaedic Surgery, Graduate School of Medicine, University of the RyukyusDepartment of Orthopaedic Surgery, Chubu Tokushukai HospitalDepartment of Orthopaedic Surgery, Graduate School of Medicine, University of the RyukyusAbstract Background The prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of blood vessels and neuroforamina. Hence, this study aimed to investigate the accuracy and clinical outcomes of PPSP using real-time 3D fluoroscopic navigation for FFP in the hybrid operating room. Methods This study included 41 patients with FFP who underwent PPSP in a hybrid operating room between April 2016 and December 2020. Intraoperative C-arm cone-beam CT was performed under general anesthesia. Guidewire trajectory was planned using a needle guidance system. The guidewire was inserted along the overlaid trajectory using 3D fluoroscopic navigation, and a 6.5 mm cannulated cancellous screw (CCS) was placed. The clinical outcomes and accuracy of the screw placement were then investigated. Results A total of 121 screws were placed. The mean operative time was 84 ± 38.7 minutes, and the mean blood loss was 7.6 ± 3.8 g. The mean time to wheelchair transfer was 2 days postoperatively. Pain was relieved in 35 patients. Gait ability from preoperative and latest follow-up after surgery was maintained in 30 (73%) patients. All 41 patients achieved bone union. Of the 121 screws, 119 were grade 0 with no misplacement; only 2 patients had grade 1 perforations. Conclusion PPSP using real-time 3D fluoroscopic navigation in a hybrid operating room was accurate and useful for early mobilization and pain relief among older patients with FFP with an already-installed needle biopsy application.https://doi.org/10.1186/s12891-022-06026-wFragility fractures of the pelvisPercutaneous screwHybrid operating room3D fluoroscopic navigationC-arm cone-beam CTNeedle guidance |
| spellingShingle | Mika Takaesu Satoshi Nakasone Yoshihide Miyata Kotaro Nishida Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room BMC Musculoskeletal Disorders Fragility fractures of the pelvis Percutaneous screw Hybrid operating room 3D fluoroscopic navigation C-arm cone-beam CT Needle guidance |
| title | Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room |
| title_full | Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room |
| title_fullStr | Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room |
| title_full_unstemmed | Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room |
| title_short | Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room |
| title_sort | real time three dimensional fluoroscopy navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room |
| topic | Fragility fractures of the pelvis Percutaneous screw Hybrid operating room 3D fluoroscopic navigation C-arm cone-beam CT Needle guidance |
| url | https://doi.org/10.1186/s12891-022-06026-w |
| work_keys_str_mv | AT mikatakaesu realtimethreedimensionalfluoroscopynavigatedpercutaneouspelvicscrewplacementforfragilityfracturesofthepelvisinthehybridoperatingroom AT satoshinakasone realtimethreedimensionalfluoroscopynavigatedpercutaneouspelvicscrewplacementforfragilityfracturesofthepelvisinthehybridoperatingroom AT yoshihidemiyata realtimethreedimensionalfluoroscopynavigatedpercutaneouspelvicscrewplacementforfragilityfracturesofthepelvisinthehybridoperatingroom AT kotaronishida realtimethreedimensionalfluoroscopynavigatedpercutaneouspelvicscrewplacementforfragilityfracturesofthepelvisinthehybridoperatingroom |