The ‘Safe Zone’ for Extra-Articular Screw Placement During Intra-Pelvic Acetabular Surgery

Guy, Pierre; Al-Otaibi, Mohammad; Harvey, Edward J.; Helmy, Näder

doi:10.1097/bot.0b013e3181bfcebf

Cited by 42 publications

(42 citation statements)

References 14 publications

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“…Several modifications of the common iliopectineal plate fixation have been reported (spring plates, infrapectineal plates, cerclages, and lag screws in different positions) [3,4,6,9,13,19,20,23,28,32,35,39] to increase the fracture fixation strength in acetabular surgery. One promising approach, especially for fractures with separation of both columns, is the use of an additional lag screw in the infraacetabular corridor to close the periacetabular fixation frame [7], but biomorphometric data of the corridor size and axis for a secure screw placement are missing.…”

Section: Discussionmentioning

confidence: 99%

“…The obturator nerve on its path from the inner pelvic ring through the obturator foramen to the outer side [34,40] and the femoral head in the acetabular cavity [13] are at risk during periacetabular screw placements and have to be preserved. Whereas the obturator nerve can be protected by direct observation in open procedures, the femoral head is obscured.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, several modifications for iliopectineal plate fixation through common anterior approaches (Letournel's ilioinguinal [21], modified Stoppa-Rives [6], or anterior intrapelvic approach [34]) have been described. Spring plates buttressing the quadrilateral plate [6], infrapectineal plates on the inner side of the pelvic rim [13,20,32], placement of additional screws parallel to the quadrilateral plate [21] or in the posterior column [3,19,28,39], and use of cerclage techniques are reported [4,9,23,35].…”

Section: Introductionmentioning

confidence: 99%

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Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

Gras

Gottschling

Schröder

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background An infraacetabular screw path facilitates the closure of a periacetabular fixation frame to increase the plate fixation strength in acetabular fractures up to 50%. Knowledge of the variance in corridor sizes and axes has substantial surgical relevance for safe screw placement. Questions/purposes (1) What proportion of healthy pelvis specimens have an infraacetabular corridor that is 5 mm or larger in diameter? (2) Does a universal corridor axis and specific screw entry point exist? (3) Are there sex-specific differences in the infraacetabular corridor size or axis and are these correlated with anthropometric parameters like age, body weight and height, or the acetabular diameter? Methods A template pelvis with a mean shape from 523 segmented pelvis specimens was generated using a CTbased advanced image analyzing system. Each individual pelvis was registered to the template using a free-form registration algorithm. Feasible surface regions for the entry and exit points of the infraacetabular corridor were marked on the template and automatically mapped to the individual samples to perform a measurement of the maximum sizes and axes of the infraacetabular corridor on each specimen. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5-mm cortical screw in clinical settings. Results In 484 of 523 pelves (93%), an infraacetabular corridor with a diameter of at least 5 mm was found. Using the mean axis angulations (54.8°[95% confidence interval {CI}, 0.6] from anterocranial to posterocaudal in relation to the anterior pelvic plane and 1.5°[95% CI, 0.4] from anteromedial to posterolateral in relation to the sagittal midline plane), a sufficient osseous corridor was present in 64% of pelves. Allowing adjustment of the three-dimensional axis by another 5°included an additional 25% of pelves. All corridor parameters were different between females and males (corridor diameter, 6.9 [95% CI, 0

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

Gras

Gottschling

Schröder

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Jakob et al [10] and more recently, Anderson et al [1] de scribed a modified approach using the Stoppa and illiac surgical window for the treatment of acetabular and pelvic ring fractures. This approach became popu lar over the past decade for anterior col umn fractures and is suitable for the ma jority of cases, while providing excellent visualization of and access to the quadri lateral plate and parts of the posterior col umn [8,26,32].…”

mentioning

confidence: 99%

The Stoppa approach for acetabular fracture

Khoury

Weill

Mosheiff

2012

Oper Orthop Traumatol

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In a 5-year review of 60 acetabular fractures that underwent open reduction and internal fixation using the modified Stoppa approach, there were 36% anterior column fractures, 28% both-column fractures, the rest being anterior column with posterior hemi transverse fractures, transverse and T-fractures. Any extension of the fracture to the iliac wing necessitated an additional lateral window (93% of cases). In cases with posterior displacement, an additional approach was utilized to address a posterior wall fracture. All fractures healed within 12 weeks. Mean Merle d'Aubigné score was 15.22. Postoperative radiological evaluation revealed anatomical reduction in 54% of the patients, satisfactory in 43%, and unsatisfactory in 3% of the patients. Overall there were 15 minor and major complications.

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“…So verlangt die korrekte Platzierung von K-Drähten und Schrauben ohne Verletzung der Iliakalgefäße, Nervenwurzeln oder des Acetabulums unter Verwendung konventioneller bildgebender Verfahren ein präzises räumliches Vorstellungsvermögen und manuelles Geschick. Die Durchführung kann mit großem Zeitaufwand, hoher Strahlenbelastung für Patient und OP-Personal sowie im schlimmsten Fall einer Fehlplatzierung des Materials und entsprechenden Komplikationen verbunden sein [2, 3]. …”

Section: Hintergrundunclassified

„3D-augmented-reality“-Visualisierung für die navigierte Osteosynthese von Beckenfrakturen

et al. 2018

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Zusammenfassung Hintergrund Trotz großer Fortschritte in der Entwicklung der Hard- und Software von Navigationssystemen finden diese aufgrund ihrer vermeintlichen Komplexität, umständlichen Integration in klinische Arbeitsabläufe und fraglichen Vorteilen gegenüber konventionellen bildgebenden Verfahren bisher wenig Einsatz in den heutigen Operationssälen. Ziel der Arbeit Entwicklung einer „Augmented-reality“(AR)-Darstellung zur chirurgischen Navigation ohne Infrarot(„IR“)-Tracking-Marker und Vergleich zum konventioneller Röntgen in einem simulierten Eingriff. Material und Methoden Navigationssystem bestehend aus „Cone-beam-CT“(CBCT)-fähigem C-Bogen und „Red-green-blue-depth“(RGBD)-Kamera. Testung durch Kirschner(K)-Draht-Platzierung in Modellen unter Berücksichtigung der benötigten Zeit, der Strahlendosis und der Benutzerfreundlichkeit der Systeme. Ergebnisse Eine signifikante Reduktion der benötigten Zeit, der Röntgenbilder und der gesamten Strahlendosis bei der AR-Navigation gegenüber dem konventionellen Röntgen bei gleichbleibender Präzision. Schlussfolgerung Die AR-Navigation mithilfe der RGBD-Kamera bietet flexible und intuitive Darstellungsmöglichkeiten des Operations-situs für navigierte Osteosynthesen ohne Tracking-Marker. Hiermit ist es möglich, Operationen schneller, einfacher und mit geringerer Strahlenbelastung für Patient und OP-Personal durchzuführen.

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The ‘Safe Zone’ for Extra-Articular Screw Placement During Intra-Pelvic Acetabular Surgery

Cited by 42 publications

References 14 publications

Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

The Stoppa approach for acetabular fracture

„3D-augmented-reality“-Visualisierung für die navigierte Osteosynthese von Beckenfrakturen

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