Quantitative anatomic basis of antegrade lag screw placement in posterior column of acetabulum

Mu, Weidong; Wang, Xianquan; Jia, Tanghong; Zhou, Dongsheng; Cheng, Aixin

doi:10.1007/s00402-009-0836-6

Cited by 28 publications

(16 citation statements)

References 14 publications

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“…Several modifications of the common iliopectineal plate fixation have been reported (spring plates, infrapectineal plates, cerclages, and lag screws in different positions) [3,4,6,9,13,19,20,23,28,32,35,39] to increase the fracture fixation strength in acetabular surgery. 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.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, several modifications for iliopectineal plate fixation through common anterior approaches (Letournel's ilioinguinal [21], modified Stoppa-Rives [6], or anterior intrapelvic approach [34]) have been described. Spring plates buttressing the quadrilateral plate [6], infrapectineal plates on the inner side of the pelvic rim [13,20,32], placement of additional screws parallel to the quadrilateral plate [21] or in the posterior column [3,19,28,39], and use of cerclage techniques are reported [4,9,23,35].…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

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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“…Generally, screw fixation of the suprapectineal plate was performed according to the safe zones for fixation of anterior and posterior column fractures [10–12]. We measured the distance of the suprapectineal screws to the joint space and found once that a screw number 7 was overreaching the subchondral bone of the acetabulum by less than 1 mm.…”

Section: Discussionmentioning

confidence: 99%

“…The screws for fixation of the suprapectineal plates (screws 1–12, Figure 1) were positioned according to the safe zones for reduction of anterior and posterior column fractures [10–12]. Depending on the fracture anatomy, holes 4–8 were used as posterior column screws and holes 7–10 as infra-acetabular screws [7].…”

Section: Methodsmentioning

confidence: 99%

“…Previously, plate designs providing quadrilateral surface buttressing proved superior in terms of fracture stability and prevention of medial subluxation as compared to traditional fracture fixation techniques [9]. Concerning (iii), screw placement with respect to “safe zones” preventing penetration of the hip joint and injury to neurovascular structures is well documented for reduction of the anterior and posterior column fractures [10–12] by the intraoperative use of an image intensifier. However, secure placement of the screw for fixation of the quadrilateral buttress plate is challenging due to its anatomical relationship to the acetabulum.…”

Section: Introductionmentioning

confidence: 99%

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Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

Egli

Keel

Cullmann

et al. 2017

BioMed Research International

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Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30–45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.

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Screw placement in percutaneous acetabular surgery: gender differences of anatomical landmarks in a cadaveric study

Dienstknecht

Müller

Sellei³

et al. 2012

International Orthopaedics (SICOT)

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Quantitative anatomic basis of antegrade lag screw placement in posterior column of acetabulum

Abstract: The present study describes a safe anchor path of antegrade lag screw fixation in the posterior column. Insertion of the lag screws of adequate length is possible in the posterior column along its functional axis.

Cited by 28 publications

References 14 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

Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

Screw placement in percutaneous acetabular surgery: gender differences of anatomical landmarks in a cadaveric study

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