A screw-view model of navigation aid retrograde transpubic screw fixation for anterior pelvic ring fracture: A case report with 28 months follow-up and technical note

RATIONALE: The purpose of this study was to evaluate the accuracy of a retrograde transpubic screw fixation assisted by a screw-view model of navigation in treating a pelvic fracture. PATIENT CONCERNS: A 30-year-old female patient injured in a motor vehicle accident, displayed symptoms characterized by swelling and pain of the pudendum. DIAGNOSES: The patient was diagnosed with a fracture of the pubic ramus. INTERVENTIONS: We used a screw-view model of navigation to assist our retrograde transpubic screw fixation in this patient. OUTCOMES: In total, 2 screws were inserted into the bilateral pubic ramus and both were excellently positioned. It took 7.4 minutes to design the screws, 8.1 minutes to implant the guidewire, and 39.3 minutes to place the screws. Intraoperative blood loss amounted to 21 mL and the total fluoroscopic time was 3.8 minutes. No clinical complications, such as neurologic, vascular, or urologic injury, infection, screw loosening, or loss of reduction, were found after the operation. Follow-up lasted 28 months. LESSONS: The outcome of our study suggests that the screw-view model of navigation maximizes the retrograde transpubic screw insertion accuracy in the treatment of a pubic ramus fracture, which is made efficient by pain relief and early out-of-bed mobilization. Our suggestion is, therefore, that the relative position between the pubic ramus and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.