Robotic assisted fixation of sacral fractures – initial experience

Robotic assisted fixation of sacral fractures – initial experienceUnstable sacral fractures are challenging for orthopaedic trauma surgeons. In most cases percutaneous fixation techniques are utilized after reduction. However, these techniuqes are not risk free mainly due to anatomical considerations. Screw misplacement is quite common and concerning. As spine surgery evolved, a miniature robotic guidance system was successfully utilized in pedicular screw insertion. The aim of the study was to demonstrate th use of the miniature robot in the fixation of unstable sacral fracutres.Patients and Methods: 9 patients with unstable sacral fracutres without significant displacement were eligible for percutaneous fixation. These included 7 traumatic fractures and 2 pathological fractures. All fixation constructs were planned using a preoperative CT scans. The patients were placed prone and the robot was mounted on a Dynamic Reference Bridge (DRB) and a 2 verification fluoroscopic images were taken. The robot was mounted on the DRB and was sent by the computer to point to the desired screw(s) trajectory. The guide wires were inserted through stab wounds and screws were placed subsequently. CT scans were made postoperatively and fluoroscopic and operative time were recorded intraoperatively. Results: Mean patient age was 29 (17-63) number of screws ranged 1-6 (average 2). Mean operative time was 50 min (range 15-90), and average fluoroscopic time was 18 sec (7-42). None was the screw was misplaced. Conclusion: Robotic assisted fixation of sacral fracture is promising. At this time it is limited to nondisplaced fractures.