Automated Screw Planning for Reduced Pelvic Fractures Based on Statistical Shape Models and Deep Learning

Percutaneous iliosacral screw fixation is an important minimally invasive treatment for unstable pelvic fractures. Because the sacroiliac region has complex anatomy and narrow screw corridors, the accuracy and safety of screw placement directly affect surgical outcomes. Accurate and reliable preoperative screw planning is therefore essential to improve surgical success and reduce intraoperative risks. Conventional preoperative planning typically requires surgeons to determine screw trajectories through manual measurements, a labor-intensive process that depends on subjective clinical experience. To address these challenges, we propose a fully automated pipeline for preoperative iliosacral screw planning in patients with pelvic fractures. Using patient-specific three-dimensional anatomy, the pipeline automatically identifies safe screw corridors and generates individualized insertion trajectories to support clinical preoperative planning. We evaluated the proposed pipeline on 200 clinical cases of pelvic fractures. Compared with conventional manual measurements, the safety margin of the safe insertion corridors increased by 2% across the four screw types, the mean planning time decreased by more than 90%, and the clinical acceptance rate reached 95%.