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Comparison of anterograde versus retrograde percutaneous screw fixation of anterior column acetabular fractures

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Percutaneous screw fixation is an effective technique in addressing minimally displaced anterior column acetabular fractures. The aim of this study is to evaluate the ease of percutaneous screw insertion for acetabular anterior column fracture, as it pertains to anterograde versus retrograde insertion techniques.

Method

From 2009 to 2013, CT imaging from 30 adult volunteers (15 males, 15 females) without history of pelvic disruption and/or morphologic abnormalities were evaluated. From these images, virtual 3D pelvic models were generated. The differences area of screw starting points, limitation position of anterior column screws, and range of screw directions were analyzed.

Conclusion

We found in our analysis that anterograde and retrograde had not only variations in their starting points, but differences in areas of insertion. Typically, anterograde portals have a larger area for insertion. Additionally, given the limitations we noted in screw position and the severity of the acetabular fractures, this will allow the treating surgeon to determine the most optimal technique for percutaneous anterior column screw fixation.

Results

In our analysis, we found two areas for effective percutaneous anterograde insertion and one area for effective retrograde insertion. They both possess geometries with different shapes. Additionally, the area of anterograde insertion is larger than the retrograde area of insertion. The limitations in screw positions were shown in the AP, inlet, outlet, iliac oblique, obturator oblique, and lateral views. The direction range between superior and inferior and between medial and lateral were measured and recorded. In area of anterograde, the angle between the superior and inferior limits was \(29.2^{\circ }\pm 2.7^{\circ }\), while the angle limit between medial and lateral was \(18.5^{\circ }\pm 1.8^{\circ }\). In area of retrograde, the angle between the superior and inferior limits was \(8.32^{\circ }\pm 1.3^{\circ }\), while the angle limit between medial and lateral was \(7.5^{\circ }\pm 0.8^{\circ }\)

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Author notes

    Authors and Affiliations

    1. Department of Orthopaedic Surgery, General Hospital of Chinese People’s Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People’s Republic of China

      Ye Peng, Lihai Zhang & Peifu Tang

    2. The Hughston Clinic, Gwinnett Medical Center, 631 Professional Drive, Suite 170, Lawrenceville, GA, 30046, USA

      William Min

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    1. Ye Peng
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    2. Lihai Zhang
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    3. William Min
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    4. Peifu Tang
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    Correspondence to Peifu Tang.

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    The authors declare that they have no conflict of interest.

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    This article does not contain any studies with human participants performed by any of the authors.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Ye Peng and Lihai Zhang contributed equally to this work.

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    Peng, Y., Zhang, L., Min, W. et al. Comparison of anterograde versus retrograde percutaneous screw fixation of anterior column acetabular fractures. Int J CARS 11, 635–639 (2016). https://doi.org/10.1007/s11548-015-1308-9

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    • DOI: https://doi.org/10.1007/s11548-015-1308-9

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