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

The use of percutaneous iliosacral screws for the treatment of unstable pelvic ring injuries is highly challenging and typically requires fluoroscopic or navigational guidance. This study aims to introduce a novel 3D-printed guide plate for the safe insertion of iliosacral screws during surgery and to evaluate the effectiveness and safety of this technique. A retrospective analysis was conducted on patients who underwent surgery for unstable posterior pelvic ring injuries at our trauma center between January 2020 and May 2023. The surgeries were performed by the same group of surgeons. Patients were divided into two groups based on different surgical methods: the guide plate group (GP group, n = 14) and the conventional surgery group (CS group, n = 17). Data on gender, cause of injury, age, sacral dysmorphism, fracture classification, time for each screw insertion, fluoroscopy time for each screw, postoperative screw position grading, follow-up duration, and fracture reduction quality at the last follow-up were recorded. The CS group included 17 patients (8 males and 9 females) with a mean age of 42.6 ± 13.4 years; the GP group included 14 patients (6 males and 8 females) with a mean age of 40.4 ± 13.1 years. There were no statistically significant differences between the two groups in terms of gender, age, cause of injury, AO fracture classification, sacral dysmorphism, follow-up duration, or fracture reduction quality. A total of 42 iliosacral screws were inserted in 31 patients, with 24 screws inserted in the CS group (18 in S1 and 6 in S2) and 18 screws inserted in the GP group (14 in S1 and 4 in S2). The GP group had significantly lower rates of screw misposition, fluoroscopy time per screw, and insertion time per screw compared to the CS group (5.56% vs. 25.00%; 0.31 ± 0.14 min vs. 0.91 ± 0.17 min; 17.29 ± 1.90 min vs. 25.18 ± 3.99 min). The differences in insertion time and fluoroscopy time per screw between the two groups were statistically significant (P < 0.05), while the difference in screw misposition rate was not statistically significant (P >0.05). The preoperative virtual screw combined with 3D guide plate technology can accurately place sacroiliac joint screws, providing a new method for percutaneous screw insertion.