The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note

Abstract Background The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture. Methods A typical case is presented in this study. An 86-year-old woman suffered from an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation were selected to optimize surgical invasiveness and proper implant placement. Results The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon. Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. Conclusions The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

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The Combination of Intraoperative CT Navigation and C-arm Fluoroscopy for INFIX and Percutaneous TITS Screw Placement in the Treatment of Pelvic Ring Injury: Technical Note

10.21203/rs.3.rs-749457/v1 ◽

2021 ◽

Author(s):

Akihiko Hiyama ◽

Taku Ukai ◽

Satoshi Nomura ◽

Masahiko Watanabe

Keyword(s):

Radiation Exposure ◽

Pelvic Ring ◽

Technical Note ◽

Pelvic Ring Fracture ◽

X Rays ◽

Ring Fracture ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Screw Insertion ◽

Rod System

Abstract BACKGROUND: The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture.METHODS: Here is a typical case. An 86-year-old woman suffered an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation was selected to optimize surgical invasiveness and proper implant placement.RESULTS: The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon.　Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. CONCLUSIONS: The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

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Development of a Patient-Specific Finite Element Model for Predicting Implant Failure in Pelvic Ring Fracture Fixation

Computational and Mathematical Methods in Medicine ◽

10.1155/2017/9403821 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Vickie Shim ◽

Andreas Höch ◽

Ronny Grunert ◽

Steffen Peldschus ◽

Jörg Böhme

Keyword(s):

Pelvic Ring ◽

Element Model ◽

Pelvic Ring Fracture ◽

Patient Specific ◽

Fe Model ◽

X Rays ◽

Ring Fracture ◽

Pelvic Ring Fractures ◽

Preoperative Ct ◽

Master Model

Introduction. The main purpose of this study is to develop an efficient technique for generating FE models of pelvic ring fractures that is capable of predicting possible failure regions of osteosynthesis with acceptable accuracy. Methods. Patient-specific FE models of two patients with osteoporotic pelvic fractures were generated. A validated FE model of an uninjured pelvis from our previous study was used as a master model. Then, fracture morphologies and implant positions defined by a trauma surgeon in the preoperative CT were manually introduced as 3D splines to the master model. Four loading cases were used as boundary conditions. Regions of high stresses in the models were compared with actual locations of implant breakages and loosening identified from follow-up X-rays. Results. Model predictions and the actual clinical outcomes matched well. For Patient A, zones of increased tension and maximum stress coincided well with the actual locations of implant loosening. For Patient B, the model predicted accurately the loosening of the implant in the anterior region. Conclusion. Since a significant reduction in time and labour was achieved in our mesh generation technique, it can be considered as a viable option to be implemented as a part of the clinical routine to aid presurgical planning and postsurgical management of pelvic ring fracture patients.

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