Optimal Technique of Screw Placement in the Ischial Tuberosity for Posterior Acetabular Fractures

1996 ◽  
Vol 10 (3) ◽  
pp. 160-164 ◽  
Author(s):  
Rongming Xu ◽  
Nabil A. Ebraheim ◽  
A. Biyani ◽  
Richard A. Yeasting
Keyword(s):  
Ischial Tuberosity ◽  
Screw Placement ◽  
Acetabular Fractures ◽  
Optimal Technique

scholarly journals Infra-acetabular screw exited between ischial tuberosity and ischial spine is more suitable for Asian population: A 3D Morphometric study

2020 ◽  
Author(s):  
Fei Liu ◽  
Xiaoreng Feng ◽  
Yang Xiao ◽  
Jie Xiang ◽  
Keyu Chen ◽  
...  
Keyword(s):  
Asian Population ◽  
3D Models ◽  
Ischial Tuberosity ◽  
Fixation Strength ◽  
Maximum Diameter ◽  
Acetabular Fractures ◽  
Morphometric Study ◽  
Exit Point ◽  
Ischial Spine ◽  
Length Direction

Abstract Background Recently, the infra-acetabular screw has been proposed for use in treatment of acetabular fractures as a part of a periacetabular fixation frame. Biomechanical studies have shown that an additional infra-acetabular screw placement can enhance the fixation strength of acetabular fracture internal fixation. Currently, the reported exit point of the infra-acetabular screw has been located at the ischial tuberosity (Screw I). However, our significant experience in placement of the infra-acetabular screw has suggested that when the exit point is located between the ischial tuberosity and the ischial spine (Screw II), the placement of a 3.5 mm infra-acetabular screw may be easier for some patients. We conducted this study in order to determine the anatomical differences between the two different IACs. Methods The raw datasets were reconstructed into 3D models using the software MIMICS. Then, the models, in the STL format model, were imported into the software Geomagic Studio to delete the inner triangular patches. Additionally, the STL format image processed by Geomagic Studio was imported again into MIMICS. Finally, we used an axial perspective based on 3D models in order to study the anatomical parameters of the two infra-acetabular screw corridors with different exit points. Hence, we placed the largest diameter virtual screw in the two different screw corridors. The data obtained from this study presents the maximum diameter, length, direction, and distances between the entry point and center of IPE. Results In 65.31% males and 40.54% females, we found a screw I corridor with a diameter of at least 5 mm, while a screw II corridor was present in 77.55% in males and 62.16% in females. Compared to screw I, the length of screw II is reduced, the angle with the coronal plane is significantly reduced, and the angle with the transverse plane is significantly increased.Conclusions For East Asians, changing the exit point of the infra-acetabular screw can increase the scope of infra-acetabular screw use, especially for females.

scholarly journals Infra-acetabular screw exited between ischial tuberosity and ischial spine is more suitable for Asian population: a 3D morphometric study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Liu ◽  
Xiaoreng Feng ◽  
Yang Xiao ◽  
Jie Xiang ◽  
Keyu Chen ◽  
...  
Keyword(s):  
Asian Population ◽  
3D Models ◽  
Ischial Tuberosity ◽  
Fixation Strength ◽  
Maximum Diameter ◽  
Acetabular Fractures ◽  
Morphometric Study ◽  
Exit Point ◽  
Ischial Spine ◽  
Length Direction

Abstract Background Recently, the infra-acetabular screw has been proposed for use in treatment of acetabular fractures as a part of a periacetabular fixation frame. Biomechanical studies have shown that an additional infra-acetabular screw placement can enhance the fixation strength of acetabular fracture internal fixation. Currently, the reported exit point of the infra-acetabular screw has been located at the ischial tuberosity (Screw I). However, our significant experience in placement of the infra-acetabular screw has suggested that when the exit point is located between the ischial tuberosity and the ischial spine (Screw II), the placement of a 3.5 mm infra-acetabular screw may be easier for some patients. We conducted this study in order to determine the anatomical differences between the two different IACs. Methods The raw datasets were reconstructed into 3D models using the software MIMICS. Then, the models, in the STL format model, were imported into the software Geomagic Studio to delete the inner triangular patches. Additionally, the STL format image processed by Geomagic Studio was imported again into MIMICS. Finally, we used an axial perspective based on 3D models in order to study the anatomical parameters of the two infra-acetabular screw corridors with different exit points. Hence, we placed the largest diameter virtual screw in the two different screw corridors. The data obtained from this study presents the maximum diameter, length, direction, and distances between the entry point and center of IPE. Results In 65.31% males and 40.54% females, we found a screw I corridor with a diameter of at least 5 mm, while a screw II corridor was present in 77.55% in males and 62.16% in females. Compared to screw I, the length of screw II is reduced, the angle with the coronal plane is significantly reduced, and the angle with the transverse plane is significantly increased. Conclusions For East Asians, changing the exit point of the infra-acetabular screw can increase the scope of infra-acetabular screw use, especially for females.

scholarly journals Digital anatomical measurements of safe screw placement at superior border of the arcuate line for acetabular fractures

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiaoxi Ji ◽  
Chun Bi ◽  
Fang Wang ◽  
Yuchen Jiang ◽  
Dongmei Wang ◽  
...  
Keyword(s):  
Screw Placement ◽  
Acetabular Fractures ◽  
Superior Border

scholarly journals CT-scan based anatomical study as a guidance for infra-acetabular screw placement

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Quanyi Lu ◽  
Runtao Zhou ◽  
Shichang Gao ◽  
Anlin Liang ◽  
Mingming Yang ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Three Dimensional ◽  
Anatomical Study ◽  
Ischial Tuberosity ◽  
Entry Point ◽  
Screw Placement ◽  
Minimum Thickness ◽  
Males And Females ◽  
The Relationship ◽  
Screw Group

Abstract Background The infra-acetabular corridor is quite narrow, which makes a challenge for the orthopedists to insert the screw. This study aimed to explore the relationship between the infra-acetabular corridor diameter (IACD) and the minimum thickness of medial acetabular wall (MTMAW), and to clarify the way of screw placement. Methods The Computed tomography (CT) data of 100 normal adult pelvises (50 males and 50 females respectively) were collected and pelvis three-dimensional (3D) reconstruction was performed by using Mimics software and the 3D model was imported into Geomagic Studio software. The perspective of acetabulum was carried out orienting from iliopubic eminence to ischial tuberosity and the IACD was measured by placing virtual screws which was vertical to the corridor transverse section of “teardrop”. The relationship between IACD and MTMAW was analyzed. When IACD was ≥5 mm, 3.5 mm all-in screws were placed. When IACD was < 5 mm, 3.5 mm in-out-in screws were placed. Results The IACD of males and females were (6.15 ± 1.24) mm and (5.42 ± 1.01) mm and the MTMAW in males and females were (4.40 ± 1.23) mm and (3.60 ± 0.81) mm respectively. The IACD and MTMAW in males were significantly wider than those of females (P < 0.05), and IACD was positively correlated with MTMAW (r = 0.859), the regression equation was IACD = 2.111 + 0.917 MTMAW. In the all-in screw group, 38 cases (76%) were males and 33 cases (66%) were females respectively. The entry point was located at posteromedial of the apex of iliopubic eminence, and the posterior distance and medial distance were (8.03 ± 2.01) mm and (8.49 ± 2.68) mm respectively in males. As for females, those were (8.68 ± 2.35) mm and (8.87 ± 2.79) mm respectively. In the in-out-in screw group, 12 cases (24%) were males and 17 cases (34%) were females, respectively. The posterior distance and medial distance between the entry point and the apex of iliopubic eminence were (10.49 ± 2.58) mm and (6.17 ± 1.84) mm respectively in males. As for females, those were (10.10 ± 2.63) mm and (6.63 ± 1.49) mm respectively. The angle between the infra-acetabular screw and the sagittal plane was medial inclination (0.42 ± 6.49) °in males, lateral inclination (8.09 ± 6.33) °in females, and the angle between the infra-acetabular screw and the coronal plane was posterior inclination (54.06 ± 7.37) °. Conclusions The placement mode of the infra-acetabular screw (IAS) can be determined preoperatively by measuring the MTMAW in the CT axial layers. Compared with all-in screw, the in-out-in screw entry point was around 2 mm outwards and backwards, and closer to true pelvic rim.

New technique and strategy for posterior column, posterior wall, ischium, and quadrilateral plate fixation from the anterior approach for acetabular fractures

2020 ◽  
Author(s):  
Kunihiro Asanuma ◽  
Gaku Miyamura ◽  
Yoshiaki Suzuki ◽  
Haruhiko Satonaka ◽  
Kakunoshin Yoshida ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Plate Fixation ◽  
Posterior Wall ◽  
Ischial Tuberosity ◽  
Posterior Column ◽  
Joint Surface ◽  
Acetabular Fractures ◽  
Quadrilateral Plate ◽  
Screw Length ◽  
Considerable Problem

Abstract BackgroundAcetabular fractures are relatively common, but management of the ischial fragment is a considerable problem when determining whether to use only the anterior approach or to add the posterior approach for anterior column and posterior hemitransverse acetabular fractures, T-type fractures, and both column fractures. This study is the first to demonstrate how to screw or drill around the quadrilateral space, posterior column, posterior wall, and near the ischial tuberosity from the anterior approach by a novel "sleeve guide technique". MethodsFirst, a nozzle, drill, depth gauge, and driver were prepared from DepuySynthes. Periosteum of the internal obturator muscle was detached from the quadrilateral plate to near the ischial tuberosity, while paying attention not to injure Alcock’s canal. The skin was cut about 1.5 cm opposite to the side of the fracture, and the nozzle was inserted as an external sleeve. Drilling, measuring screw length, and screwing were performed through this nozzle. With this technique, the approach angles of drilling and screwing to the posterior wall and ischium were inclined, and plating from the ischium to the ilium could be performed from the anterior approach. ResultsTwo cases are presented. Case 1 was a 63-year-old man who had a left both column fracture with a free bone fragment of the joint surface. After plating a 14-hole plate from the pubis to the ilium, a bent 14-hole plate was placed at the quadrilateral space as a buttress, and a screw was inserted from the posterior wall to the ilium using sleeve guide technique. Case 2 was a 66-year-old man with a quadrilateral fracture. After a 13-hole plate was bent and placed at the quadrilateral space, screws were inserted to the ischium and posterior wall using sleeve guide technique ConclusionsSleeve guide technique is very easy, useful, and safe to drill and insert screws to the quadrilateral space, posterior wall, and near the ischial tuberosity from the anterior approach. This technique can be used for simple drilling and screwing of a small T buttress plate held by a ball spike at the quadrilateral space from the surgical window. We believe that these techniques lead to new strategies for acetabular fractures.

scholarly journals Measurement of the “Safe Zone” and the “Dangerous Zone” for the Screw Placement on the Quadrilateral Surface in the Treatment of Pelvic and Acetabular Fractures with Stoppa Approach by Computational 3D Technology

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Sheng Zhang ◽  
Wanhan Su ◽  
Qiang Luo ◽  
Frankie Leung ◽  
Bin Chen
Keyword(s):  
Human Subjects ◽  
3D Models ◽  
Safe Zone ◽  
Screw Placement ◽  
Acetabular Fractures ◽  
Computer Assisted ◽  
Pelvic Brim ◽  
Stoppa Approach ◽  
Dangerous Zone ◽  
The Absolute

This study is aimed at definition of the safe and dangerous zone for screw placement with Stoppa approach for rapid identification during operation and a new way for the studies on the “safe zone.” Pelvic CT data of 84 human subjects were recruited to reconstruct the three-dimensional (3D) models. The distances between the edges of the “safe zone,” “dangerous zone,” and specific anatomic landmarks such as the obturator canal and the pelvic brim were precisely measured, respectively. The results show that the absolute “dangerous zone” was from the pelvic brim to 3.07 cm below it and within 2.86 cm of the obturator canal, while the region 3.56 cm below the pelvic brim or 3.85 cm away from the obturator canal was the absolute “safe zone” for screw placement. The region between the absolute “safe zone” and the absolute “dangerous zone” was the relatively “dangerous zone.” As a conclusion, application of computer-assisted 3D modeling techniques aids in the precise measurement of “safe zone” and “dangerous zone” in combination with Stoppa incision. It was not recommended to place screws on the absolute dangerous zone, while, for the relatively “dangerous zone,” it depends on the individual variations in bony anatomy and the fracture type.

scholarly journals Traumatic obturator–anterior type dislocation of the hip with an ipsilateral ischial tuberosity and greater trochanter fractures: Case report

2020 ◽  
pp. 221049172097898
Author(s):  
Juan Manuel Concha ◽  
Humberto Gonzalez ◽  
Andrea C Montero ◽  
Nelsy B Mueses ◽  
Heydy Y Muñoz ◽  
...  
Keyword(s):  
Hip Dislocation ◽  
Femoral Fractures ◽  
High Energy ◽  
Ischial Tuberosity ◽  
Harris Hip Score ◽  
Acetabular Fractures ◽  
Functional Evaluation ◽  
Greater Trochanter ◽  
Anterior Hip Dislocation ◽  
Trochanter Fracture

Anterior hip dislocation is a rare orthopedic emergency, usually following high-energy trauma. This injury is occasionally associated with acetabular fractures, femoral head fractures, or diaphyseal femoral fractures. However, the combination between the anterior hip dislocation and the ipsilateral ischial tuberosity and greater trochanter fractures is extremely rare, and very sparsely reported in the literature. This paper reports a case of an obturator type of anterior hip dislocation associated with a concomitant ipsilateral ischial tuberosity and greater trochanter fracture. The hip dislocation was reduced by closed means under general anesthesia, and the greater trochanter fracture was reduced and internally fixed with tension band in a second stage. Radiological and functional evaluation at 12 months after surgery, using the Harris Hip Score (HHS), was good.

scholarly journals Infra-acetabular screw exited between ischial tuberosity and ischial spine is more suitable for Asian population: A 3D Morphometric study

2020 ◽  
Author(s):  
Fei Liu ◽  
Xiaoreng Feng ◽  
Yang Xiao ◽  
Jie Xiang ◽  
Keyu Chen ◽  
...  
Keyword(s):  
Asian Population ◽  
3D Models ◽  
Ischial Tuberosity ◽  
Fixation Strength ◽  
Maximum Diameter ◽  
Acetabular Fractures ◽  
Morphometric Study ◽  
Exit Point ◽  
Ischial Spine ◽  
Length Direction

Abstract Background Recently, the infra-acetabular screw has been proposed for use in treatment of acetabular fractures as a part of a periacetabular fixation frame. Biomechanical studies have shown that an additional infra-acetabular screw placement can enhance the fixation strength of acetabular fracture internal fixation. Currently, the reported exit point of the infra-acetabular screw has been located at the ischial tuberosity (Screw I). However, our significant experience in placement of the infra-acetabular screw has suggested that when the exit point is located between the ischial tuberosity and the ischial spine (Screw II), the placement of a 3.5 mm infra-acetabular screw may be easier for some patients. We conducted this study in order to determine the anatomical differences between the two different IACs. Methods The raw datasets were reconstructed into 3D models using the software MIMICS. Then, the models, in the STL format model, were imported into the software Geomagic Studio to delete the inner triangular patches. Additionally, the STL format image processed by Geomagic Studio was imported again into MIMICS. Finally, we used an axial perspective based on 3D models in order to study the anatomical parameters of the two infra-acetabular screw corridors with different exit points. Hence, we placed the largest diameter virtual screw in the two different screw corridors. The data obtained from this study presents the maximum diameter, length, direction, and distances between the entry point and center of IPE. Results In 65.31% males and 40.54% females, we found a screw I corridor with a diameter of at least 5 mm, while a screw II corridor was present in 77.55% in males and 62.16% in females. Compared to screw I, the length of screw II is reduced, the angle with the coronal plane is significantly reduced, and the angle with the transverse plane is significantly increased.Conclusions For East Asians, changing the exit point of the infra-acetabular screw can increase the scope of infra-acetabular screw use, especially for females.

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

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
R. J. Egli ◽  
M. J. B. Keel ◽  
J. L. Cullmann ◽  
J. D. Bastian
Keyword(s):  
Hip Joint ◽  
Fracture Fixation ◽  
Intraoperative Imaging ◽  
Weight Bearing ◽  
Operating Time ◽  
Screw Placement ◽  
Acetabular Fractures ◽  
Partial Weight Bearing ◽  
Partial Weight ◽  
Buttress Plate

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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