Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 2, pp 189–195 | Cite as

Factors influencing the accuracy of iliosacral screw insertion using 3D fluoroscopic navigation

  • Masaki TakaoEmail author
  • Hidetoshi Hamada
  • Takashi Sakai
  • Nobuhiko Sugano
Trauma Surgery



The purpose of the present study was to determine which factors affect the positional accuracy of iliosacral screws inserted using 3D fluoroscopic navigation. Specifically, we asked: (1) does the screw insertion angle in the coronal and axial planes affect the positional accuracy of iliosacral screw insertion using 3D fluoroscopic navigation? (2) Is the positional accuracy of iliosacral screw insertion using 3D fluoroscopic navigation affected by the type of screw (transsacral versus standard iliosacral), site of screw insertion (S1 versus S2), patient position (supine versus prone), presence of a dysmorphic sacrum, or AO/OTA classification (type B versus C)?

Materials and methods

Twenty-seven patients with AO/OTA type B or C pelvic ring fracture were treated by percutaneous iliosacral screw fixation. A total of 55 screws were inserted into S1 or S2 using 3D fluoroscopic navigation combined with preoperative CT-based planning. The positional accuracy of screw placement was assessed by matching postoperative CT images with preoperative CT images. The distance between the central axis of the inserted screw and that of the planned screw placement was measured in the sagittal plane passing through the center of the vertebral body.


The mean deviation between the planned and the inserted screw position was 2.9 ± 1.7 mm (range 0–8.5 mm) at the vertebral body center. Multiple regression analysis showed that the screw insertion angle relative to the vertical line of the bone surface in the axial plane (β = 0.354, p = 0.013) and the use of a transsacral screw (β = 0.317, p = 0.017) were correlated with the positional accuracy of screw placement (adjusted R2 = 0.276, p = 0.002).


A greater screw insertion angle relative to the vertical line on the bone surface and the use of transsacral screws increases the positional error of iliosacral screws inserted using 3D fluoroscopic navigation.

Level of evidence

Level IV, therapeutic study.


3D fluoroscopic navigation Accuracy Iliosacral screw Transsacral screw Screw insertion angle CT-based plan 



We thank Prof. Hideki Yoshikawa from Osaka University for his advice and criticism and Kelly Zammit, BVSc, from Edanz Group (, for editing a draft of this manuscript.


No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Medical EngineeringOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka University Graduate School of MedicineSuitaJapan

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