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01-04-2013 | Original Paper

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

Authors: Thomas Dienstknecht, Michael Müller, Richard Sellei, Michael Nerlich, Franz Josef Müller, Bernd Fuechtmeier, Arne Berner

Published in: International Orthopaedics | Issue 4/2013

Abstract

Purpose

Percutaneous reduction and periarticular screw implantation techniques have been successfully introduced in acetabular surgery. The advantages of this less invasive approach are attenuated by higher risks of screw misplacement. Anatomical landmarks are strongly needed to prevent malplacement. This cadaver study was designed to identify reliable anatomical osseous landmarks in the pelvic region for screw placement in acetabular surgery. Gender differences were specifically addressed.

Methods

Twenty-seven embalmed cadaveric hemipelvic specimens (13 male, 14 female) were used. After soft-tissue removal, anterior and posterior column acetabular screw placement was conducted by one orthopaedic trauma surgeon under direct vision. Each column was addressed by antegrade and retrograde screw insertion. Radiographic verification of ideal screw placement was followed by assessment of the distance from the different entry points to adjoining anatomical osseous structures.

Results

For anterior column screw positioning, the posterior superior iliac spine (PSIS), posterior inferior iliac spine (PIIS), iliopectineal eminence and centre of the symphysis were most reliable regarding gender differences. For posterior column screw positioning, the distance to the anterior superior iliac spine (ASIS) and the ischial tuberosity showed the lowest deviation between the different gender specimens. Highest gender differences were seen in relation to the cranial rim of the superior pubic ramus in retrograde anterior column screw positioning (p = 0.002). Most landmarks could be targeted within a 2.5-cm range in all specimens.

Conclusions

The findings emphasise the relevance of osseous landmarks in acetabular surgery. By adhering to easily identifiable structures, screw placement can be safely performed. Significant gender differences must be taken into consideration during preoperative planning.

Culemann U, Holstein JH, Kohler D, Tzioupis CC, Pizanis A, Tosounidis G, Burkhardt M, Pohlemann T (2010) Different stabilisation techniques for typical acetabular fractures in the elderly–a biomechanical assessment. Injury 41(4):405–410PubMedCrossRef

Gary JL, VanHal M, Gibbons SD, Reinert CM, Starr AJ (2011) Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation. J Orthop Trauma 26(5):278–283CrossRef

Guy P, Al-Otaibi M, Harvey EJ, Helmy N (2010) The ‘safe zone’ for extra-articular screw placement during intra-pelvic acetabular surgery. J Orthop Trauma 24(5):279–283PubMedCrossRef

Kendoff D, Citak M, Gardner MJ, Stubig T, Krettek C, Hufner T (2009) Intraoperative 3D imaging: value and consequences in 248 cases. J Trauma 66(1):232–238PubMedCrossRef

Crowl AC, Kahler DM (2002) Closed reduction and percutaneous fixation of anterior column acetabular fractures. Comput Aided Surg 7(3):169–178PubMedCrossRef

Routt ML Jr, Simonian PT, Grujic L (1995) The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique. J Orthop Trauma 9(1):35–44PubMedCrossRef

Stockle U, Hoffmann R, Nittinger M, Sudkamp NP, Haas NP (2000) Screw fixation of acetabular fractures. Int Orthop 24(3):143–147PubMedCrossRef

Yu YH, Tseng IC, Su CY, Huang JW, Wu CC (2012) Modified technique of percutaneous posterior columnar screw insertion and neutralization plate for complex acetabular fractures. J Trauma 71(1):198–203CrossRef

Hong G, Cong-Feng L, Cheng-Fang H, Chang-Qing Z, Bing-Fang Z (2011) Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation. Arch Orthop Trauma Surg 130(9):1177–1183CrossRef

10.

Vioreanu MH, Mulhall KJ (2011) Intra-operative imaging technique to aid safe placement of screws in percutaneous fixation of pelvic and acetabular fractures. Acta Orthop Belg 77(3):398–401PubMed

11.

Puchwein P, Enninghorst N, Sisak K, Ortner T, Schildhauer TA, Balogh ZJ, Pichler W (2012) Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion. Arch Orthop Trauma Surg 132(6):805–811PubMedCrossRef

12.

Chang JK, Gill SS, Zura RD, Krause WR, Wang GJ (2001) Comparative strength of three methods of fixation of transverse acetabular fractures. Clin Orthop Relat Res 392:433–441PubMedCrossRef

13.

Kazemi N, Archdeacon MT (2011) Immediate full weightbearing after percutaneous fixation of anterior column acetabulum fractures. J Orthop Trauma 26(2):73–79CrossRef

14.

Mu WD, Wang XQ, Jia TH, Zhou DS, Cheng AX (2009) Quantitative anatomic basis of antegrade lag screw placement in posterior column of acetabulum. Arch Orthop Trauma Surg 129(11):1531–1537PubMedCrossRef

15.

Benedetti JA, Ebraheim NA, Xu R, Yeasting RA (1996) Anatomic considerations of plate-screw fixation of the anterior column of the acetabulum. J Orthop Trauma 10(4):264–272PubMedCrossRef

16.

Xian-quan W, Jin-fang C, Xue-cheng C, Wei-dong M, Wei Z, Shui S, Jin-lu Z, Jian W, Wei L (2010) A quantitative anatomic study of plate-screw fixation of the acetabular anterior column through an anterior approach. Arch Orthop Trauma Surg 130(2):257–262PubMedCrossRef

17.

Simonian PT, Routt ML Jr, Harrington RM, Tencer AF (1994) Internal fixation of the unstable anterior pelvic ring: a biomechanical comparison of standard plating techniques and the retrograde medullary superior pubic ramus screw. J Orthop Trauma 8(6):476–482PubMed

18.

Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc CH, Fischer JF, Moretti B, Leyvraz PF (2005) Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury 36(11):1330–1336PubMedCrossRef

19.

Carmack DB, Moed BR, McCarroll K, Freccero D (2001) Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography. J Bone Joint Surg Am 83-A(9):1370–1375PubMed

20.

Norris BL, Hahn DH, Bosse MJ, Kellam JF, Sims SH (1999) Intraoperative fluoroscopy to evaluate fracture reduction and hardware placement during acetabular surgery. J Orthop Trauma 13(6):414–417PubMedCrossRef

Title: Screw placement in percutaneous acetabular surgery: gender differences of anatomical landmarks in a cadaveric study
Authors: Thomas Dienstknecht
Michael Müller
Richard Sellei
Michael Nerlich
Franz Josef Müller
Bernd Fuechtmeier
Arne Berner
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 4/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-012-1740-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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