Description of Standardized Planes and Angles for Percutaneous Supra-acetabular Screw Placement

Abstract

Background Percutaneous screw fixation for pelvic fractures has become a minimally invasive alternative to an open operation. The complex anatomy of the pelvis renders this procedure challenging. The objective of this study was to assess standardized angles and dimensions of safety zones within a 3 D computed tomography model for optimal supra-acetabular screw placement.

Methods Computed tomography scans of 107 patients that suffered major trauma without showing any bone injury of the pelvis were collected. Using a software-based analysis, raw computed tomography data were transformed into 3 D models to set standardized landmarks and determine the possible insertion corridor.

Results Screws not exceeding a length of 97 mm in females and 106.4 mm in males were, in 95% of the evaluated cases, insertable without cortical bone penetration. The safety zone was 6.6 mm for females and 7.9 mm for males. Screws not exceeding these diameters were safely insertable in 95% of the cases. For the midsagittal plane, the angle was 36.4 ± 5.1 on the left and 34.7 ± 2.9 on the right (p = 0.008). For the anterior pelvic plane, the angle was 31.3 ± 4.5° on the left and 34.0 ± 4.8° on the right (p = 0.008).

Conclusions Percutaneous fixation using supra-acetabular screws is a promising method to treat simple supra-acetabular fractures. These results may improve its safe utilization and could facilitate its broader clinical application.

Zusammenfassung

Hintergrund Die perkutane Schraubenosteosynthese hat sich bei Beckenfrakturen zu einer minimalinvasiven Alternative zum offen chirurgischen Vorgehen entwickelt, wobei die komplexe Anatomie des Beckens das Verfahren zu einer Herausforderung macht. Das Ziel der vorliegenden Arbeit ist es, standardisierte Winkel und Abmessungen des knöchernen Schraubenkanals, anhand von dreidimensionalen CT-Modellen zur Platzierung der supraazetabulären Schraube zu bewerten.

Methoden Es wurden Computertomographie-Scans von 107 Patienten rekonstruiert, die ein schweres Trauma erlitten, ohne dass eine Knochenverletzung des Beckens auftrat. Mithilfe einer softwarebasierten Analyse wurden CT-Rohdaten in 3 D-Modelle umgewandelt, um standardisierte Orientierungspunkte zu setzen und den möglichen Insertionskorridor zu bestimmen.

Ergebnisse Schrauben, die eine Länge von 97 mm bei Frauen und 106,4 mm bei Männern nicht überschritten, waren in 95% der ausgewerteten Fälle ohne Perforation der Kortikalis einbringbar. Die Sicherheitszone betrug 6,6 mm für Frauen bzw. 7,9 mm für Männer. Schrauben, die diese Durchmesser nicht überschritten, konnten in 95% der Fälle sicher eingebracht werden. Für die Mittelsagittalebene (MSP) betrug der Winkel 36,4 ± 5,1 links und 34,7 ± 2,9 rechts (p = 0,008). Für die vordere Beckenebene (APP) betrug der Winkel 31,3 ± 4,5° links und 34,0 ± 4,8° rechts (p = 0,008).

Schlussfolgerungen Die perkutane Fixierung mit supraazetabulären Schrauben ist eine vielversprechende Methode zur Behandlung einfacher supraazetabulärer Frakturen. Diese vorliegenden Ergebnisse können bei der Implantation als Referenzwerte dienen und eine sichere Verwendung erleichtern.

Keywords

pelvis - pelvic ring fractures - screw insertion angle - supraacetabular screw

Schlüsselwörter

Trauma - Beckenfrakturen - supraazetabuläre Schraube - Beckenring - minimalinvasive Osteosynthese

Publication History

Received: 24 October 2022

Accepted after revision: 06 June 2023

Article published online:
18 July 2023

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