The use of three-dimensional navigation and advanced intraoperative imaging in minimally invasive pelvic and acetabular fracture fixation: A systematic review

Pelvic and acetabular fractures are challenging injuries to treat. This review evaluates three-dimensional intraoperative imaging and navigation-guided percutaneous SI, trans-iliac, trans-sacral, and acetabular screw placement versus conventional methods performed with C-arm imaging. A systematic search of MEDLINE, Embase, and Cochrane was performed. Two reviewers independently extracted data into a collaborative data form designed a priori and piloted prior to its use. Descriptive statistics are presented where applicable. Summary statistics analysis was presented based on the fracture type. Continuous data such as fluoroscopic and operative time were compared with unpaired Student t-test and pooled data of revision rate and complications were compared with chi-square analysis with an alpha set at 0.05. The rate of complications using conventional fluoroscopy was 11.3% (26/230) compared to three-dimensional navigation (6.7% (40/597), X 2 (DF: 1, N = 827) = 4.79, p = .028.) which translated to a higher rate of revision surgeries in the conventional fluoroscopy group (10.9% vs. 0.8%) X 2 (DF: 1, N = 827) = 47.8, p ≤.001. Average fluoroscopic time was lower for studies using three-dimensional navigation (28.8 ± 14.3 s, n = 71) compared to conventional fluoroscopy (57.8 ± 4.2 s, n = 38, p ≤.001). Three-dimensional navigation during minimally invasive pelvis and acetabular fracture fixation may have some benefits. Level of evidence: IV.