Infra-Acetabular Corridor—Technical Tip for an Additional Screw Placement to Increase the Fixation Strength of Acetabular Fractures

Culemann, Ulf; Marintschev, Ivan; Gras, Florian; Pohlemann, Tim

doi:10.1097/ta.0b013e3181f45f91

Cited by 52 publications

(81 citation statements)

References 2 publications

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“…1C). Contrary to the initial description of the screw insertion technique by Culemann et al [7], with more surgical experience and optimized retractors, the area for the screw entry point can be visualized [2] and the infraacetabular screw placed through the anterior intrapelvic approach.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas the obturator nerve can be protected by direct observation in open procedures, the femoral head is obscured. The best fluoroscopic plane to exclude intraarticular misplacement is the projection of the screw as a dot in the teardrop figure [7] or use of an intraoperative CT-or 3-D c-arm scan [15,17,18]. The benefit of CT or 3-D c-arm scan evaluation has to be weighted against additional radiation exposure individually for each patient.…”

Section: Discussionmentioning

confidence: 99%

“…One promising approach, especially for fractures with separation of both columns, is the use of an additional lag screw in the infraacetabular corridor to close the periacetabular fixation frame [7], but biomorphometric data of the corridor size and axis for a secure screw placement are missing. Based on 523 CT scans of pelves specimens, a corridor with a diameter of at least 5 mm exists in 93% of cases (90% in females versus 94% in males; not significant).…”

Section: Discussionmentioning

confidence: 99%

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Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

Gras

Gottschling

Schröder

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background An infraacetabular screw path facilitates the closure of a periacetabular fixation frame to increase the plate fixation strength in acetabular fractures up to 50%. Knowledge of the variance in corridor sizes and axes has substantial surgical relevance for safe screw placement. Questions/purposes (1) What proportion of healthy pelvis specimens have an infraacetabular corridor that is 5 mm or larger in diameter? (2) Does a universal corridor axis and specific screw entry point exist? (3) Are there sex-specific differences in the infraacetabular corridor size or axis and are these correlated with anthropometric parameters like age, body weight and height, or the acetabular diameter? Methods A template pelvis with a mean shape from 523 segmented pelvis specimens was generated using a CTbased advanced image analyzing system. Each individual pelvis was registered to the template using a free-form registration algorithm. Feasible surface regions for the entry and exit points of the infraacetabular corridor were marked on the template and automatically mapped to the individual samples to perform a measurement of the maximum sizes and axes of the infraacetabular corridor on each specimen. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5-mm cortical screw in clinical settings. Results In 484 of 523 pelves (93%), an infraacetabular corridor with a diameter of at least 5 mm was found. Using the mean axis angulations (54.8°[95% confidence interval {CI}, 0.6] from anterocranial to posterocaudal in relation to the anterior pelvic plane and 1.5°[95% CI, 0.4] from anteromedial to posterolateral in relation to the sagittal midline plane), a sufficient osseous corridor was present in 64% of pelves. Allowing adjustment of the three-dimensional axis by another 5°included an additional 25% of pelves. All corridor parameters were different between females and males (corridor diameter, 6.9 [95% CI, 0

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

Gras

Gottschling

Schröder

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…2. Does the placement of an additional screw in the infraacetabular corridor, recently described, 7 increase the fixation strength independent of the used construct?…”

Section: Questions Posed In This Studymentioning

confidence: 99%

“…7 The plates in group I were contoured to fit along the linea iliopectinea and fixed with five screws. The additional infraacetabular screw was placed via the plate.…”

Section: Tested Groupsmentioning

confidence: 99%