Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 3 , ISSUE 1 ( January-June, 2021 ) > List of Articles

Original Article

Technical Trick to Avoid Intra-articular Screw Placement in Posterior Wall Fractures of the Acetabulum

Ramesh Perumal, Sudipta K Patra, Sivakumar S Palanivelayutham, Avinash Mahender, Dheenadhayalan Jayaramaraju, Shanmuganathan Rajasekaran

Citation Information : Perumal R, Patra SK, Palanivelayutham SS, Mahender A, Jayaramaraju D, Rajasekaran S. Technical Trick to Avoid Intra-articular Screw Placement in Posterior Wall Fractures of the Acetabulum. 2021; 3 (1):7-12.

DOI: 10.5005/jp-journals-10079-1035

License: CC BY-NC 4.0

Published Online: 07-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Screw placement at the posterior margin of the acetabulum while operating for wall fractures requires additional care to avoid articular penetration which can lead to poor functional outcomes. The main objective of this study is to describe a simple four-step surgical guide to avoid intra-articular screw penetration during fixation. Materials and methods: We prospectively analyzed 23 patients (21 males and 2 females) with posterior wall acetabular fractures treated with the described technique in our institution from 2017 to 2019. Of these 23 patients, 8 patients had isolated posterior wall fractures, 9 patients had transverse with posterior wall fracture, and 6 patients had posterior wall and column fractures. Radiograph Judet views and computerized tomography (CT) scan were done in all the patients to check for intra-articular screws on the second postoperative day. Results: By radiograph and CT scan in all the patients, there was no intra-articular screw penetration noticed following acetabular fracture fixation. All the 23 patients in our study had a good functional outcome with Merle D'aubigne score of ≥18 in 12 patients and ≥10 in 11 patients. Conclusion: Good knowledge of the osseous anatomy of the pelvis is essential to prevent intra-articular screw placement during fixation of acetabular fractures. Our four-step surgical tip to insert periacetabular screws under direct vision helps prevent intra-articular screw placement during acetabular fracture fixation by posterior approach. Besides, this technique is easily reproducible and helps to minimize intraoperative radiation time.


HTML PDF Share
  1. Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed., New York, NY: Springer; 1993. pp. 67–88.
  2. Matta JM. Fracture of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. Orthopedic Trauma Directions 2011;9(02):31–36. DOI: 10.1055/s-0030-1267077.
  3. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res 2003;407(407):173–186. DOI: 10.1097/00003086-200302000- 00026.
  4. Giannoudis PV, Tzioupis C, Moed BR. Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg Br Vol 2007;89(4):503–509. DOI: 10.1302/0301-620X.89B4. 18380.
  5. Wu X, Chen W, Zhang Q, et al. The study of plate-screw fixation in the posterior wall of acetabulum using computed tomography images. J Trauma Acute Care Surg 2010;69(2):423–431. DOI: 10.1097/TA.0b013e3181ca05f6.
  6. Kellam JF, Tile M. Surgical techniques. In: Tile M, ed. Fractures of the Pelvis and Acetabulum. 2nd ed., Baltimore: Williams and Wilkins; 1995. pp. 355–396.
  7. Carmack DB, Moed BR, McCarroll K, et al. Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography. JBJS 2001;83(9):1370–1375. DOI: 10.2106/00004623-200109000-00012.
  8. Ebraheim NA, Savolaine ER, Hoeflinger MJ, et al. Radiological diagnosis of screw penetration of the hip joint in acetabular fracture reconstruction. J Orthop Trauma 1989;3(3):196–201. DOI: 10.1097/00005131-198909000-00003.
  9. Tile M, Helfet DL, Kellam JF. Fractures of the Pelvis and Acetabulum. Baltimore: Williams & Wilkins; 1995. pp. 419–495.
  10. Letournel E. Acetabulum fractures: classification and management. Orthop Trauma Directi 2007;5(05):27–33. DOI: 10.1055/s-2007-980136.
  11. Guy P, Al-Otaibi M, Harvey EJ, et al. The ‘safe zone’ for extra-articular screw placement during intra-pelvic acetabular surgery. J Orthop Trauma 2010;24(5):279–283. DOI: 10.1097/BOT.0b013e3181bfcebf.
  12. Sullivan MP, Baldwin KD, Donegan DJ, et al. Geriatric fractures about the hip: divergent patterns in the proximal femur, acetabulum, and pelvis. Orthopedics 2014;37(3):151–157. DOI: 10.3928/01477447-20140225-50.
  13. Gras F, Marintschev I, Klos K, et al. Screw placement for acetabular fractures: which navigation modality (2-dimensional vs. 3-dimensional) should be used? An experimental study. J Orthop Trauma 2012;26(8):466–473. DOI: 10.1097/BOT.0b013e318234d443.
  14. Li Z, Li J, Li Z, et al. Comparative study of anatomical locking plate and reconstruction plate in treating acetabular fractures. Int Orthop 2021. 1–8. DOI: 10.1007/s00264-021-04970-1.
  15. Yoon S, Park M, Matsuda DK, et al. Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty. BMC Musculoskel Disord 2018;19(1):1–6. DOI: 10.1186/s12891-018-2091-x.
  16. Ayob KA, Merican AM, Sulaiman SH, et al. The tale of two vessels, vascular complications following a breach of the pelvic inner table due to acetabular screws: a report of two cases. J Dis Relat Surg 2021;32(1):239–244.
  17. Bosse MJ. Posterior acetabular wall fracture: a technique for screw placement. J Orthop Trauma 1991;5(2):167–172. DOI: 10.1097/00005131-199105020-00008.
  18. Duncan JM, Nahas S, Akhtar K, et al. The use of a 3D printer in pre-operative planning for a patient requiring acetabular reconstructive surgery. J Orthop Case Rep 2015;5(1):23. DOI: 10.13107/jocr.2250-0685.247.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.