Radiological Diagnosis of Screw Penetration of the Hip Joint in Acetabular Fracture Reconstruction

Ebraheim, Nabil A.; Savolaine, Edward R.; Hoeflinger, Michael; Jackson, William T.

doi:10.1097/00005131-198909000-00003

Cited by 35 publications

(34 citation statements)

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“…Um das Risiko dennoch zu verringern, wurden für spezielle Osteosynthesetechniken (z. B. Acetabulumrekonstruktion) besondere Bildwandlerprojektionen oder die intraoperative Arthrographie empfohlen [1]. Mit der CT-basierten Navigation lässt sich die Fehlplatzierungsrate reduzieren, was durch klinische Studien zur Instrumentation an der Wirbelsäule nachgewiesen werden konnte [7,14].…”

Section: Diskussionunclassified

Vergleichende Untersuchung zur Qualität der C-Bogen-basierten 3D-Bildgebung am Talus

Euler¹,

Wirth

Linsenmaier

et al. 2001

Der Unfallchirurg

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Malposition of extraosseous or intra-articular screws, e.g., in osteosyntheses of joint fractures or in the vicinity of joints, frequently remains undiscovered in intraoperative fluoroscopy and is only recognized on postoperative computed tomography (CT) scans. The aim of the study, therefore, was to assess the value of a new mobile C-arm three-dimensional imaging device in comparison with fluoroscopy, conventional radiographs, and CT scans using an extremity model. Screws were inserted ventrally in four anatomic lower leg specimens without talus fractures parallel to the longitudinal axis to simulate surgical management of fractures of the talus. The specimens supplied were examined with fluorscopy, conventional radiography, spiral CT, and the new three-dimensional imaging with the SIREMOBIL Iso-C3D. These four modalities were evaluated by ten radiologists and ten trauma surgeons and were compared regarding subjective image quality and position of the screws. The quality of information acquired with the SIREMOBIL Iso-C3D was equal to that of the CT examinations, although image quality was considered inferior to fluoroscopy, conventional radiography, and CT (p < 0.001). In contrast to the previous procedure with intraoperative fluoroscopy and subsequent postoperative X-ray control, the results obtained with the SIREMOBIL IsoC3D were superior. The SIREMOBIL Iso-C3D is useful for the intraoperative diagnosis of small joints with few artifacts producing osteosynthesis material, i.e., for recognizing the position of screws in the region of glenoid surfaces.

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Section: Diskussionunclassified

Vergleichende Untersuchung zur Qualität der C-Bogen-basierten 3D-Bildgebung am Talus

Euler¹,

Wirth

Linsenmaier

et al. 2001

Der Unfallchirurg

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“…Postoperative CT is generally accepted as the most accurate technique for the detection of intra-articular screws[25–27]. However, intraoperative CT scans are not available in the majority of operating rooms, especially in developing countries.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopic views for safe insertion of lag screws into the posterior column of the acetabulum

Chen

Zhang

Yang

et al. 2014

BMC Musculoskelet Disord

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BackgroundPercutaneous lag screw fixation is an alternative treatment for non-displaced or minimally displaced posterior column fractures. This study aims to explore new fluoroscopic views of the acetabulum for safe percutaneous insertion of posterior column lag screws.MethodsAxial computed tomography (CT) scans were taken of sixteen embalmed adult cadavers. The axial CT images at the level of the middle height of the acetabulum were selected. The angle (angle α) between the posterior cortex of the posterior column (PCPC) and the line intersecting the axial plane and the coronal plane, and the angle (angle β) between the medial wall and the line intersecting the axial plane and the sagittal plane were identified and measured. Tangential views of the PCPC and medial wall were obtained by referencing the measured angles. A lag screw was inserted into the posterior columns of the sixteen pelvic specimens under fluoroscopic guidance using an iliac oblique view and the two tangential views. CT scans were performed to evaluate the lag screw position. Axial CT images of 52 volunteers were obtained and the angles α and β were measured following the same methods used for the cadaveric specimens.ResultsThe angles α and β for the specimens were 29.3±2.8.1 and 8.1±1.4 degrees, respectively. On the tangential view of the PCPC, the posterior cortex appears as a nearly straight line between the lesser and greater sciatic notches. On the tangential view of the medial wall, the medial wall appears as a distinct straight line. Using these radiographic images, the lag screws were inserted into the posterior columns of bony pelvic specimens. Screw placement was confirmed by CT, and found to be fully intraosseous in all cases without any cortical breaches. The angles α and β were 30.4±4.1 and 9.2±1.9 degrees for male volunteers and 28.5±3.7 and 7.7±1.8 degrees for female volunteers, significant difference in these angles between cadaveric specimens and human volunteers.ConclusionThe tangential views of both the PCPC and medial wall can be obtained following the aforementioned methods The oblique iliac view and the two tangential views enable safe insertion of posterior column lag screws.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-303) contains supplementary material, which is available to authorized users.

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“…Further, double plating of the posterior column has been recommended in order to improve fracture stability and decrease possible complications by avoiding the technically more demanding placement of lag screws (R. Winquist, personal communication). The dangers of penetrating the joint or the pelvis by screws, and the extreme precautions taken to avoid this complication, have been stressed by most authors [1,2,9,10,12].…”

Section: T H E M E a N O V E R A L L Stiffness O F The 10 Intact And mentioning

confidence: 99%

“…Operation carries risks of the usual general and local complications of infection, deep vein thrombosis, sciatic nerve palsy and heterotopic ossification. There may also be specific problems associated with internal fixation such as intra-articular penetration of screws or loss of fixation, which may lead to the rapid development of osteoarthritis or chondrolysis [1,2,5,7,14].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of methods of fixation of isolated osteotomies of the posterior acetabular column

Schopfer

DiAngelo

Hearn

et al. 1994

International Orthopaedics

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Ten fresh frozen specimens of a hemipelvis, including the hip joint, capsule and proximal femur, from elderly cadavers were used to evaluate three methods of internal fixation of isolated posterior column osteotomies. Intact and reconstructed specimens were tested at 30 degrees and 60 degrees of hip flexion in a specially designed joint simulator. The three methods of fixation used were a single 3.5 mm reconstruction plate, two such plates, and a 4.5 mm lag screw with a single plate. Motion at the fracture site in three orthogonal directions, and the overall stiffness of the construct, were recorded simultaneously. No significant differences were noted in stiffness for the three procedures and all retained 80% of the intact stiffness. At 60 degrees of flexion, smaller interfragmentary compliances were allowed by fixation with a lag screw and a neutralisation plate (p < 0.05). At 30 degrees, the position of the load plane relative to the fracture plane allowed less interfragmentary motion, so that no significant differences were found between the 3 methods.

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Radiological Diagnosis of Screw Penetration of the Hip Joint in Acetabular Fracture Reconstruction

Cited by 35 publications

References 0 publications

Vergleichende Untersuchung zur Qualität der C-Bogen-basierten 3D-Bildgebung am Talus

Vergleichende Untersuchung zur Qualität der C-Bogen-basierten 3D-Bildgebung am Talus

Fluoroscopic views for safe insertion of lag screws into the posterior column of the acetabulum

Biomechanical comparison of methods of fixation of isolated osteotomies of the posterior acetabular column

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