Introduction: Fragility fractures of the pelvis (FFPs) have become increasingly common due to population aging and rising osteoporosis rates. Surgical interventions, such as percutaneous screw fixation, are often preferred to avoid the complications associated with prolonged bed rest. However, using conventional fluoroscopy for screw placement in FFP surgeries presents challenges due to inadequate imaging clarity, difficulty achieving precise screw placement, and high radiation exposure to surgeons and staff. This study aims to evaluate the effectiveness of the O-arm navigation system compared to conventional fluoroscopy in FFP surgeries, focusing on screw placement accuracy, radiation exposure, and overall surgical outcomes.
Methods: This retrospective, multicenter study included 72 patients diagnosed with FFPs and treated surgically from 2020 to 2024. Patients were divided into two groups: those treated with the O-arm navigation system (O group, n=14) and those treated with conventional fluoroscopy (C group, n=58). Patient demographics, including age, sex, and bone mineral density, were collected from electronic medical records. The primary evaluation metrics were radiation exposure to the surgeon and screw placement accuracy. Secondary metrics included operative time, intraoperative blood loss, and reoperation rates. Radiation exposure was measured using dosimeters positioned to simulate operative conditions for both systems, while screw placement accuracy was assessed using postoperative CT scans taken seven days after surgery. Statistical analyses were conducted to compare the two groups using SPSS software, with p-values <0.05 considered statistically significant.
Results: No significant differences in demographics were observed between the O and C groups. Radiation exposure to surgeons was markedly lower in the O group (0.1–0.2 µSv) compared to the C group, where the mean exposure was 109.8 ± 61.3 mGy. Screw perforation rates were also lower in the O group (5.7%) compared to the C group (20%). Notably, no patients in the O group required reoperation, whereas three patients in the C group experienced complications necessitating reoperation. However, the O group exhibited a longer operative time (80.1 ± 27.8 min vs. 51.9 ± 23 min) and higher blood loss (39.6 ± 52.8 ml vs. 9.8 ± 28 ml) compared to the C group.
Discussion: The O-arm navigation system significantly enhanced screw placement accuracy and reduced radiation exposure for surgeons in FFP surgery compared to conventional fluoroscopy. Although operative times and blood loss were higher in the O group, this may be due to the greater complexity of cases managed with O-arm guidance. The system’s enhanced visualization allowed for accurate screw placement even in complex pelvic anatomy, potentially reducing reoperation rates. These findings suggest that O-arm navigation improves precision and safety in FFP surgeries, supporting its use as an effective tool to optimize patient outcomes and minimize complications.