Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion

Puchwein, Paul; Enninghorst, Natalie; Sisák, Krisztián; Ortner, Thomas; Schildhauer, Thomas A.; Balogh, Zsolt J.; Pichler, Wolfgang

doi:10.1007/s00402-012-1486-7

Cited by 52 publications

(40 citation statements)

References 19 publications

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“…In contradiction to these studies with no sex-related difference in the anterior column corridor axis, different infraacetabular corridor axes in females (4°medial tilt in relation to the sagittal midline plane) and males (almost parallel orientation with a lateral tilt of 0.3°in relation to the sagittal midline plane) were observed in this study. This is in line with data from Puchwein et al reporting different screw angulations in male versus female pelves for the supraacetabular and posterior column, but not the anterior column [31].…”

Section: Discussionsupporting

confidence: 92%

“…The infraacetabular corridor diameter was significantly larger in males compared with females, as reported for the anterior column corridor in several studies [5,30,31]. In contradiction to these studies with no sex-related difference in the anterior column corridor axis, different infraacetabular corridor axes in females (4°medial tilt in relation to the sagittal midline plane) and males (almost parallel orientation with a lateral tilt of 0.3°in relation to the sagittal midline plane) were observed in this study.…”

Section: Discussioncontrasting

confidence: 86%

“…Numerous biomorphometric studies have investigated different osseous corridors for placement of screws in the supraacetabular region or the anterior or posterior column [5,8,30,31,37], but data for the infraacetabular corridor are missing. Only one experimental study investigated percutaneous placement of an infraacetabular screw [10].…”

Section: Discussionmentioning

confidence: 99%

“…Small sample sizes in previous studies limit the statistical analysis of periacetabular corridor parameters and their correlation with several anthropomorphic parameters [1,5,8,30,31,37]. An automatic registration and analyzing algorithm is one strength of this study facilitating large data acquisition of 523 pelves.…”

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: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Multiple attempts at drill bit or screw insertion in such a narrow corridor of cancellous bone may create a void and will affect the purchase of the final screws. To achieve reduction and fixation of the acetabular fracture using screws, the corridors of bone through which these screws pass must contain sufficient cancellous and cortical bone to allow safe passage of the necessary drill bits and screws, and to obtain sufficient fixation to achieve adequate acetabular stability [5].…”

mentioning

confidence: 99%

In-out-in technique for acetabular fractures: is it really good?

Meena

Digge

2012

International Orthopaedics (SICOT)

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Biomorphometric analysis of ilio‐sacro‐iliacal corridors for an intra‐osseous implant to fix posterior pelvic ring fractures

Gras

Hillmann

Rausch

et al. 2014

Journal Orthopaedic Research

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It is hypothesized that ilio-sacro-iliacal corridors for a new envisioned pelvic ring implant (trans-sacral nail with two iliacal bolts ¼ ISI-nail: ilio-sacro-iliacal nail) exists on the level of S1-or S2-vertebra in each patient. The corridors of 84 healthy human pelves (42x <; 42x ,, 18-85 years) were measured in high resolution CT scans using the Merlin Diagnostic Workcenter Software. Trans-sacral corridors (!9 mm diameter) on the level of S1 and S2 were found in 62% and 54% of pelves with a mean length [mm AE SD] of 164 AE 12.9 and 142 AE 10.2. Corresponding iliac corridors were present in all specimens in caudally tilted axial planes of 37.8 AE 0.67å nd 53.7 AE 0.94˚in relation to the operating table plane and divergent angulations of 69.0 AE 0.49˚and 70.1 AE 0.32˚in relation to the sagittal midline plane. Sacral dysmorphism, with compensatory larger S2 corridors were prevalent in 24% of pelves; ilio-sacro-iliacal osseous corridors for the envisioned implant were found in 88% of pelves on the level of S1 or S2. In the remaining 12% with too narrow corridors for any trans-sacral implant (screws, bars, ISI nail) alternative fixation methods have to be considered. Expected advantages of the envisioned ISI nail compared to available fixation devices are discussed. ß

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Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion

Cited by 52 publications

References 19 publications

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

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

In-out-in technique for acetabular fractures: is it really good?

Biomorphometric analysis of ilio‐sacro‐iliacal corridors for an intra‐osseous implant to fix posterior pelvic ring fractures

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