An investigation to the clinical application of personalized 3D printed guides combined with preoperative virtual iliosacral screws for the management of posterior pelvic ring injury

Abstract

Purpose Percutaneous iliosacral screws are difficult to utilise to treat pelvic ring instability injuries, and they usually require navigational or fluoroscopic guidance. The goal of this study is to create a unique 3D-printed guide for iliosacral screw insertion during surgery and evaluate its effectiveness and safety. Methods The same group of surgeons did a retrospective examination of patients who received surgery for an unstable posterior pelvic ring injury at our hospital's trauma centre between January 2020 and May 2023, in accordance with the selection criteria. Patients were categorised into two groups: the conventional surgery (CS) group (n = 17) and the 3D guide plate (GP) group (n = 14), based on the surgical techniques employed, the following variables were documented: Gender, age, cause of injury, sacral dysmorphism, fracture classification, screw insertion time, radiation exposure time for each screw, postoperative screw position grading, follow-up period, and fracture reduction quality. Results The CS group consisted of 17 patients, nine female and eight male, with an average age of 42.6 ± 13.4 years. A total of 14 patients presented with the GP group, consisting of eight females and six males, with an average age of 40.4 ± 13.1. The two groups had no statistically significant differences in sacral dysmorphism, follow-up time, fracture reduction quality, gender, age, cause of injury, or AO fracture classification (p > 0.05). A total of 42 iliosacral screws were inserted in 31 patients: 24 screws in the CS group (18 S1 and 6 S2), and 18 screws in the GP group (14 S1 and 4 S2). In comparison to the CS group, the GP group had substantially lower rates of screw misposition, radiation exposure time per screw, and insertion time per screw (5.56% versus 25.00%; 0.31 ± 0.14min versus 0.91 ± 0.17min; 17.29 ± 1.90min versus 25.18 ± 3.99min). Comparisons between the two groups regarding the duration of radiation exposure for each screw, and the time required to insert each screw were all statistically significant (p < 0.05), however, there was no significant difference in the rate of screw misposition between the two groups (P > 0.05). Conclusion In combination with 3D guide plate technology, the preoperative virtual screw can precisely position the iliosacral screw, thereby introducing a novel technique for percutaneous iliosacral screw placement.