The use of 3D computer-assisted navigation and its influence on radiation exposure and operation time in the surgical treatment of fragility fractures of the pelvis.

Abstract

Percutaneous screw fixation is increasingly being used for stabilization of pelvic fragility fractures (FFP) in the elderly. Performing this procedure using 2D fluoroscopy is challenging due to the complex anatomy of the pelvis. 3D computer-assisted navigational imaging techniques have emerged to facilitate the procedure. This study compares traditional 2D fluoroscopy with 3D computer-assisted navigation regarding radiation exposure and operation time in patients with FFP. This retrospective study included patients treated with percutaneous screws for FFP between 1st of January 2017, and 31th of May 2023. Patients were divided into two groups: those treated with conventional 2D fluoroscopy (2D-CF) and those with 3D computer-assisted navigation (3D-CAN). Data on demographics, ASA scores, fracture types and operative parameters were collected. The outcomes were intraoperative fluoroscopy time, operation time and complications. Statistical analyses were conducted, with statistical significance determined at p < 0.05. Eighteen patients were included in each group. There were no significant differences in baseline patient characteristics between the groups. Compared to 2D-CF (190.3 ± 86.9 s, p = 0.000), 3D-CAN showed a significant reduction in fluoroscopy time (78.4 ± 33.7 s). The mean operative time was also significantly higher in 2D-CF (85.0 ± 28.1 min, p = 0.007) versus 3D-CAN (62.1 ± 18.3 min). In 3D-CAN no screw-related complications were observed. In surgical treatment of pelvis fragility fractures percutaneous screw fixation with 3D computer-assisted navigation systems significantly reduces patient radiation exposure and operative time in comparison to conventional intraoperative 2D imaging.