Robot-assisted frame screws placement for the surgical management of complex acetabular fractures: a single-center retrospective study

Abstract

BACKGROUND: The traditional freehand placement of frame screws (infra-acetabular, IAS; posterior column screw, PCS) is difficult due to narrow osseous corridors, risking joint penetration and neurovascular damage. We hypothesize that robot-assisted placement could reduce iatrogenic injuries, improve surgical efficiency, and make the process safer and more precise. This study aims to assess the surgical and clinical outcomes of using robot-assisted frame screws for complex acetabular fractures versus the freehand method. METHODS: From April 2020 to July 2023, 45 patients with complex acetabular fractures who received surgical treatment in our department were included in a retrospective analysis. The 45 patients were sorted into two groups, A (robot-assisted, n = 21) and B (freehand, n = 24), based on the frame screws placement methods. Blood loss, surgical time, frame screws placement time and accuracy, number of fluoroscopies and guide pin adjustments, incision length, fracture reduction quality, hip function and complications were compared between the two groups. RESULTS: Compared to the patients in group B, those in group A had significantly shorter surgical time (-26 min) and frame screws placement time (-21 min), lower blood loss (-125 ml), fewer guide pin adjustments (-8) and fluoroscopies (-24), as well as higher frame screws placement perfect rate (+ 13%). There were no significant differences in the quality of fracture reduction and hip function between the two groups. The iatrogenic neurovascular injury rate was lower in group A (4.8%) compared to group B (12.5%), and the incision length was shorter by 1 cm in group A, yet neither difference was statistically significant. CONCLUSION: Robot-assisted frame screws placement is a safe and precise method for managing complex acetabular fractures, especially for those with narrow osseous corridors or poor general condition. It surpasses the traditional freehand technique by reducing blood loss, shortening placement time, increasing the precision, and minimizing guide pin adjustments and fluoroscopies.