scholarly journals Digital anatomical study and clinical application of screw placement for quadrilateral plate fractures in the danger zone

2020 ◽  
Author(s):  
Bei Zhao ◽  
Zhongye Sun ◽  
Wei Zhang ◽  
Zhongbao Xu ◽  
Xiaofei Yang ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Three Dimensional ◽  
Anatomical Study ◽  
Chinese Patients ◽  
Screw Placement ◽  
Insertion Point ◽  
Danger Zone ◽  
Ilioinguinal Approach ◽  
Quadrilateral Plate ◽  
The Mean

Abstract Background Direct screw placement for quadrilateral plate fractures in the danger zone of the acetabulum is very difficult. This study was performed to simulate the surgical procedure and try to obtain effective and safe screw angles through the middle window of the ilioinguinal approach in Chinese patients. Methods We randomly collected the pelvic computed tomography (CT) scans of 50 adults. DICOM-formatted CT-scan images were imported into Mimics software. The three-dimensional reconstruction (3D) digital model of the semi-pelvi s was established. A 3.5 mm cylinder was used to simulate the pathway of the screw from the designated insertion point . The angles of insertion and intersex differences were explored by statistical analyses. Results The screws could be inserted via three angles: medial inclination , anterior inclination and posterior inclination. The mean minimum medial inclination angle (MIMIA) of insertion point A was 4.96°±1.11° in males and 8.66°±3.40° in females, and the intersex difference was significant. The mean minimum medial inclination angle (MIMIA) of insertion point B was -5.31°±3.69° in males and 1.75°±8.95° in females, and the intersex difference was significant. There were no differences between any of the angles for males and females at insertion point O. Conclusions Preoperative measurement and calculation by digital tools before screw placement for quadrilateral plate fractures of the acetabulum are feasible. Double cortical screws could be placed safely in the danger zone through the middle window of the ilioinguinal approach to increase the stability of the acetabulum.

scholarly journals Digital anatomical study of screw placement for quadrilateral plate through the middle window of ilioinguinal approach

2019 ◽  
Author(s):  
Bei Zhao ◽  
Weidong Mu
Keyword(s):  
Inclination Angle ◽  
Three Dimensional ◽  
Anatomical Study ◽  
Chinese Patients ◽  
Screw Placement ◽  
Insertion Point ◽  
Ilioinguinal Approach ◽  
Quadrilateral Plate ◽  
Dimensional Reconstruction ◽  
The Mean

Abstract Background Screw placement directly for quadrilateral plate fractures of the acetabulum is very difficult. This study was performed to simulate the surgical procedure and try to obtain effective and safe screw angles through the middle window of ilioinguinal approach in Chinese patients. Methods We randomly collected the pelvic computed tomography (CT) scans of 50 adults. DICOM-formatted CT-scan images were imported into Mimics software. The three-dimensional reconstruction (3D) digital model of the semi-pelvic was established. In the coronal and sagittal planes, a 3.5 mm cylinder was used to simulate the pathway of the screw from the designated insertion point. The angles of insertion and intersex differences were explored by statistical analyses. Results The screws could be inserted via four angles: medial inclination, lateral inclination, anterior inclination and posterior inclination. The mean minimum medial inclination angle (MIMIA) of insertion point A was 4.96°±1.11° in males and 8.66°±3.40° in females, and the intersex difference was significant. The mean minimum medial inclination angle (MIMIA) of insertion point C was -5.31°±3.69° in males and 1.75°±8.95° in females, and the intersex difference was significant. There were no differences in all the angles between males and females in insertion point B. Conclusions Preoperative measurement and calculation by digital tools before the screw placement for quadrilateral plate fractures of the acetabulum are feasible. Double cortical screws could be placed safely through the middle window of ilioinguinal approach to increase the stability of acetabulum.

scholarly journals Three-Dimensional Analysis of the Characteristics of the Femoral Canal Isthmus: An Anatomical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Xiu-yun Su ◽  
Jing-xin Zhao ◽  
Zhe Zhao ◽  
Li-cheng Zhang ◽  
Chen Li ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Anatomical Study ◽  
3D Models ◽  
Chinese Patients ◽  
Tube Length ◽  
Femoral Canal ◽  
New Approach ◽  
Femoral Length ◽  
Intramedullary Canal ◽  
The Mean

Purpose. To establish a new approach for measuring and locating the femoral intramedullary canal isthmus in 3-dimensional (3D) space.Methods. Based on the computed tomography data from 204 Chinese patients, 3D models of the whole femur and the corresponding femoral isthmus tube were reconstructed using Mimics software (Materialise, Haasrode, Belgium). The anatomical parameters of the femur and the isthmus, including the femur length and radius, and the isthmus diameter and height, were measured accordingly.Results. The mean ratio of the isthmus height versus the femoral height was 55 ± 4.8%. The mean diameter of the isthmus was 10.49 ± 1.52 mm. The femoral length, the isthmus diameter, and the isthmus tube length were significantly larger in the male group. Significant correlations were observed between the femoral length and the isthmus diameter (r=0.24,p<0.01) and between the femoral length and the isthmus height (r=0.6,p<0.01). Stepwise linear regression analyses demonstrated that the femoral length and radius were the most important factors influencing the location and dimension of the femoral canal isthmus.Conclusion. The current study developed a new approach for measuring the femoral canal and for optimization of customer-specific femoral implants.

scholarly journals Anatomical Study of the Clavicles in a Chinese Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Xu-sheng Qiu ◽  
Xiao-bo Wang ◽  
Yan Zhang ◽  
Yan-Cheng Zhu ◽  
Xia Guo ◽  
...  
Keyword(s):  
Chinese Population ◽  
Three Dimensional ◽  
Anatomical Study ◽  
Anatomical Studies ◽  
Intramedullary Canal ◽  
Significant Difference ◽  
New Development ◽  
Clavicle Fractures ◽  
The Mean ◽  
Two Sides

Background. A reemergence of interest in clavicle anatomy was prompted because of the advocacy for operative treatment of midshaft clavicle fractures. Several anatomical studies of the clavicle have been performed in western population. However, there was no anatomical study of clavicle in Chinese population.Patients and Methods. 52 patients were included in the present study. Three-dimensional reconstructions of the clavicles were generated. The length of the clavicle, the widths and thicknesses of the clavicle, curvatures of the clavicle, the areas of the intramedullary canal, and sectional areas of the clavicle were measured. All the measurements were compared between genders and two sides.Results. The mean length of the clavicles was144.2±12.0 mm. Clavicles in males were longer, wider, and thicker than in females; also males have different curvatures in both planes compared with females. The men’s intramedullary canals and sectional areas of the clavicle were larger than those of women. No significant difference between the sides was found for all the measurements.Conclusion. This study provided an anatomical data of the clavicle in a Chinese population. These clavicle dimensions can be applied to the modifications of the contemporary clavicle plate or a new development for the Chinese population.

Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement

2003 ◽  
Vol 99 (3) ◽  
pp. 324-329 ◽  
Author(s):  
Langston T. Holly ◽  
Kevin T. Foley
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Content Type ◽  
Image Guided ◽  
Spinal Navigation ◽  
Mean Diameter ◽  
The Mean ◽  
Fine Print

✓ The authors sought to evaluate the feasibility and accuracy of three-dimensional (3D) fluoroscopic guidance for percutaneous placement of thoracic and lumbar pedicle screws in three cadaveric specimens. After attaching a percutaneous dynamic reference array to the surgical anatomy, an isocentric C-arm fluoroscope was used to obtain images of the region of interest. Light-emitting diodes attached to the C-arm unit were tracked using an electrooptical camera. The image data set was transferred to the image-guided workstation, which performed an automated registration. Using the workstation display, pedicle screw trajectories were planned. An image-guided drill guide was passed through a stab incision, and this was followed by sequential image-guided pedicle drilling, tapping, and screw placement. Pedicle screws of various diameters (range 4–6.5 mm) were placed in all pedicles greater than 4 mm in diameter. Postoperatively, thin-cut computerized tomography scans were obtained to determine the accuracy of screw placement. Eighty-nine (94.7%) of 94 percutaneous screws were placed completely within the cortical pedicle margins, including all 30 lumbar screws (100%) and 59 (92%) of 64 thoracic screws. The mean diameter of all thoracic pedicles was 6 mm (range 2.9–11 mm); the mean diameter of the five pedicles in which wall violations occurred was 4.6 mm (range 4.1–6.3 mm). Two of the violations were less than 2 mm beyond the cortex; the others were between 2 and 3 mm. Coupled with an image guidance system, 3D fluoroscopy allows highly accurate spinal navigation. Results of this study suggest that this technology will facilitate the application of minimally invasive techniques to the field of spine surgery.

scholarly journals Supra-ilioinguinal versus modified Stoppa approach in the treatment of acetabular fractures: reduction quality and early clinical results of a retrospective study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Yanhui Ji ◽  
Fengzhao Zhu ◽  
Lian Zeng ◽  
...  
Keyword(s):  
Operative Time ◽  
Clinical Results ◽  
Acetabular Fractures ◽  
Ilioinguinal Approach ◽  
Quadrilateral Plate ◽  
Stoppa Approach ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Approach Group

Abstract Background To compare the efficacy of the operative techniques, complications, reduction quality and hip functional recovery by using the supra-ilioinguinal approach and the modified Stoppa approach for the management of acetabular fractures. Methods A consecutive cohort of 60 patients from September 2014 to October 2017 with displaced acetabular fractures involving the quadrilateral plate were treated operatively with supra-ilioinguinal approach (group A) and modified Stoppa approach (group B), respectively. There were 36 patients in group A and 24 patients in group B. The surgical details, complications, radiographic and clinical results were recorded. The quality of reduction was assessed by measuring the residual step and gap displacement of postoperative CT with a standardized digital method. Results The complications, reduction quality (gaps and steps) and hip function recovery had no significant statistical difference in approaches. The mean operative time was shorter and the mean intraoperative haemorrhage was less in group A. There were statistical differences in the operative time (P = 0.025) and intraoperative haemorrhage (P = 0.003) between the supra-ilioinguinal approach and the modified Stoppa approach. Conclusion Compared to the modified Stoppa approach, the supra-ilioinguinal approach provides a closer visualization to the quadrilateral plate, the operative time was shorter and the intraoperative haemorrhage was clearly less. It is at least equal to or could be a better choice to deal with complicated acetabular fractures especially involving the quadrilateral plate and the anterior one third of the iliac bone.

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.

scholarly journals The largest secure corridor of the infra-acetabular screw—a 3-D axial perspective analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bei Zhao ◽  
Wei Zhang ◽  
Hao Li ◽  
Liren Han ◽  
Shizhang Han ◽  
...  
Keyword(s):  
Maximum Length ◽  
Posterior Column ◽  
Chinese Patients ◽  
Maximum Diameter ◽  
Insertion Point ◽  
Screw Insertion ◽  
Significant Difference ◽  
The Mean ◽  
The Right ◽  
Perspective Analysis

Abstract Background The infra-acetabular screw which is placed from the pubis to the ischium can be used as a special positional screw of the posterior column of the acetabulum. This study was performed to simulate the surgical procedure and obtain the ideal insertion point, diameter, length and angle of the screw through the method of axial perspective in Chinese patients. Methods We randomly collected the pelvic computed tomography (CT) scans of 200 adults. DICOM-formatted CT-scan images were imported into Mimics software to establish the 3D digital model of the right semi-pelvic was established. A virtual cylinder representing the screw was placed from the pubis to the ischium to fix the posterior column. The largest secure diameter and length of the virtual screw were measured and the position of the insertion point and the directions of the screw were also researched. Results The screw insertion safe zone exhibits an irregular shape of “tear drop” in the reconstructed pelvic model. The mean maximum diameter of screws was 5.01 ± 1.28 mm, and the mean maximum length of screws was 93.99 ± 8.92 mm. The screw insertion corridor with the least diameter 3.5 mm was found in 94 of 100 males (94%) and 86 of 100 females (86%). We found gender-dependent differences for the mean maximum diameter and the maximum length of the screw. There was statistically significant difference between genders in the position of insertion point. Conclusions In this study, we suggest an individual preoperative 3D reconstruction simulation to develop better screw placement plans, which provides a valuable guideline for seeking the largest secure corridor of infra-acetabular screw. Further biomechanical studies are needed to verify the function of the screw.

scholarly journals Talar Dome Investigation and Talocrural Joint Axis Analysis Based on Three-Dimensional (3D) Models: Implications for Prosthetic Design

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Da-Hang Zhao ◽  
Di-Chao Huang ◽  
Gong-Hao Zhang ◽  
Yun-Ping Fan ◽  
Jian Yu ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Implant Design ◽  
Lateral Ligament ◽  
Neutral Position ◽  
Talar Dome ◽  
Talocrural Joint ◽  
Joint Axis ◽  
The Mean

Ankle joint kinematics is mainly stabilized by the morphology of the talar dome and the articular surface of tibiofibular mortise as well as the medial and lateral ligament complexes. Because of this the bicondylar geometry of talus dome is believed to be crucial for ankle implant design. However, little data exist describing the precise anatomy of the talar dome and the talocrural joint axis. The aim of this study is to document the anatomy of the talar dome and the axis of the talocrural joint using three-dimensional (3D) computed tomographic (CT) modeling. Seventy-one participants enrolled for CT scanning and 3D talar model reconstruction. All the ankles were held in a neutral position during the CT scanning. Six points on the lateral and medial crest of the talar dome were defined. The coordinate of the six points; radii of lateral-anterior (R-LA), lateral-posterior (R-LP), medial-anterior (R-MA), and medial-posterior (R-MP) sections; and inclination angle of the talar dome were measured, and the inclination and deviation angles of the talocrural joint axis were determined. The mean values of R-LA, R-LP, R-MA, and R-MP were 19.23 ± 2.47 mm, 18.76 ± 2.90 mm, 17.02 ± 3.49 mm, and 22.75 ± 3.04 mm. The mean inclination angle of the talar dome was 9.86 ± 3.30 degrees. Gender variation was found in this parameter. The mean inclination and deviation angles were 8.60 ± 0.07 and 0.76 ± 0.69 degrees for the dorsiflexion axis and −7.34 ± 0.07 and 0.09 ± 0.18 degrees for the plantarflexion axis. Bilateral asymmetries between the medial and lateral crest of the talar dome were found, which resulted in different dorsiflexion and plantarflexion axes of the talocrural joint. Currently, no ankle implants replicate this talar anatomy, and these findings should be considered in future implant designs.

scholarly journals A guideline for screw fixation of coracoid process base fracture by 3D simulation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhongye Sun ◽  
Hao Li ◽  
Bei Wang ◽  
Jun Yan ◽  
Liren Han ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Safe Zone ◽  
Coracoid Process ◽  
Chinese Patients ◽  
Ct Scans ◽  
Insertion Point ◽  
Screw Insertion ◽  
The Mean ◽  
The Right ◽  
The Ideal

Abstract Background Fractures of the base of the coracoid process are relatively rare, but an increasing number of studies have reported using screws to fix coracoid process base fractures. This study was performed to simulate the surgical procedure and obtain the ideal diameter, length, insertion point and angle of the screw from a 3-D axial perspective in Chinese patients. Methods We randomly collected right scapula computed tomography (CT) scans from 100 adults. DICOM-formatted CT scan images were imported into Mimics software. A 3D digital model of the right scapula was established. Two virtual cylinders representing two screws were placed from the top of the coracoid process to the neck of the scapula and across the base of the coracoid process to fix the base of the coracoid process. The largest secure diameters and lengths of the virtual screws were measured. The positions of the insertion points and the directions of the screws were also examined. Results The screw insertion safe zone can exhibit an irregular fusiform shape according to the reconstructed scapula model. The mean maximum diameters of the medial and lateral screws were 7.08 ± 1.19 mm and 7.34 ± 1.11 mm, respectively. The mean maximum lengths of the medial and lateral screws were 43.11 ± 6.31 mm and 48.16 ± 6.94 mm, respectively. A screw insertion corridor with a diameter of at least 4.5 mm was found in all patients. We found sex-dependent differences in the mean maximum diameters and maximum lengths of the two screws. The positions of the two insertion points were statistically different across sexes. Conclusions The study provides a valuable guideline for determining the largest secure corridor for two screws in fixing a fracture at the base of the coracoid process. For ideal screw placement, we suggest individualised preoperative 3D reconstruction simulations. Further biomechanical studies are needed to verify the function of the screws.

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