Acetabular fracture surgery follows the primary aim of anatomic reduction and rigid stable fixation of the fracture. Infraacetabular screws (IAS) allow for an increased stability of the acetabular fixation by closing the periacetabular fixation frame without requiring an additional posterior approach. The osseous screw corridor for infraacetabular screws use the transition zone between the acetabular ring and the obturator ring. The infraacetabular screw corridor (IAC) shows a double-cone shape with an isthmus located near the acetabular fovea. The iliopectineal eminence (IE) is mainly used as a clinical landmark for the intraoperative assessment of the entry point of IAS. The inlet view, the combined obturator oblique outlet view and a 1/3 iliac oblique outlet view may be used for the intraoperative radiological assessment for both the entry point and the screw trajectory of IAS. Several biomechanical studies have shown that IAS increase the stiffness of the internal fixation. Scientific proof for an improved clinical outcome is still missing.
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| http://dx.doi.org/10.1007/s00402-024-05528-7 | DOI Listing |
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[Experiences with the infra-acetabular screw placement technique in acetabular fracture surgery].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi
September 2024
Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China.
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Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Anichstraße 35, Innsbruck, 6020, Austria.
Acetabular fracture surgery follows the primary aim of anatomic reduction and rigid stable fixation of the fracture. Infraacetabular screws (IAS) allow for an increased stability of the acetabular fixation by closing the periacetabular fixation frame without requiring an additional posterior approach. The osseous screw corridor for infraacetabular screws use the transition zone between the acetabular ring and the obturator ring.
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Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Introduction: Traditionally, plate osteosynthesis of the anterior column combined with an antegrade posterior column screw is used for fixation of anterior column plus posterior hemitransverse (ACPHT) acetabulum fractures. Replacing the posterior column screw with an infraacetabular screw could improve the straightforwardness of acetabulum surgery, as it can be inserted using less invasive approaches, such as the AIP/Stoppa approach, which is a well-established standard approach. However, the biomechanical stability of a plate osteosynthesis combined with an infraacetabular screw instead of an antegrade posterior column screw is unknown.
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June 2024
Department of Orthopedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata, Kitaku, Okayama City, Okayama, 700-8558 Japan.
Background: In acetabular fracture surgery, an infra-acetabular screw (IAS) is inserted from the anterior to the posterior column through the infra-acetabular corridor to stabilize both columns. Although the IAS is useful for increasing fixation strength, proper placement requires proficiency and often results in extraosseous screw penetration. The complex anatomy of the infra-acetabular corridor and difficult intraoperative detection of the ideal insertion point and angle make proper placement of the IAS challenging.
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