ARTICLESPercutaneous Screw Insertion for Acetabular and Sacral FracturesKahler, David M. M.D.Author Information From the Department of Orthopaedic Trauma, University of Virginia Health System, Charlottesville, Virginia. Address correspondence and reprint requests to David M. Kahler, MD, Associate Professor, Director of Orthopaedic Trauma, University of Virginia Health System, Box 800159, Charlottesville, VA 22908-0159. E-mail: Dmk7y@virginia.edu The equipment used in this study was on loan from Medtronic/Sofamor-Danek and Smith & Nephew. The author is a consultant for Smith & Nephew. Techniques in Orthopaedics: June 2003 - Volume 18 - Issue 2 - p 174-183 Buy Abstract Summary Orthopaedic trauma has long been identified as a potential impact area for the new field of image-guided surgery. Early experience with three-dimensional (3-D) computed tomography-based image-guided surgery was promising, but this particular technique was limited by the inability to update the 3-D computer model in the operating room after fracture reduction maneuvers or implant placement. Virtual fluoroscopy, or fluoroscopic navigation, became available in 1999 and has proven to be a more versatile technology for fracture management. Fluoroscopic navigation systems allow the surgeon to store multiple intraoperative fluoroscopic images on a computer workstation; the position of special optically tracked surgical instruments or implants can then be virtually overlaid onto the stored images in multiple planes during implant placement. The ability to update images after fracture manipulation has now expanded the application of computer-assisted surgery to any procedure that has traditionally relied on intraoperative C-arm use. In selected pelvic trauma applications, this technology has been shown to decrease both operative time and intraoperative radiation exposure. This review covers the current use of surgical navigation in implant placement around the pelvis. © 2003 Lippincott Williams & Wilkins, Inc.