Abstract
BackgroundInfra-acetabular screws enhance the fixation strength in acetabular fractures with separation of both columns. Placement without iatrogenic femoral head violation is challenging.PurposeTo assess the impact of the acetabular configuration, the patients’ age and gender on safe infra-acetabulum screw insertion.MethodsIn 112 patients (69 females; mean age: 34 years, range 17–88; n = 200 hips), the lateral center–edge angle (LCE) was measured on radiographs. Using corresponding axial CT scans the residual distance from (the lateral border) of the screw to (the medial border of) the femoral head (“Screw-to-Femoral Head distance”; “RD_SFH”) was determined. Statistical analysis was carried out using linear regression, multiple linear regression and normal distribution estimation.ResultsThe mean (range) LCE angle was 30° (7°–51°) and the mean (range) “RD_SFH” was 5 mm (1–14 mm). The linear regression model shows a significant linear relation between LCE and “RD_SFH” with a slope parameter of − 0.15 (p value < 0.0001), the Pearson correlation between LCE and “RD_SFH” is − 0.56 (CI [− 0.71, [− 0.40]). Age did not have a significant impact on the relation between LCE and “RD_SFH” (p value 0.85). Compared to male patients, in females, the intercept is 4.62 mm (p value 0.0005) less, the slope parameter is 0.09 (p value 0.029) larger.ConclusionThe virtual possibility to place an infra-acetabular screw was given in all patients. An increasing depth of the acetabulum correlated with a decrease in residual distances. As hip joint cartilage thickness was not considered in measurements, intraoperative rule-out of screw mispositioning especially in deep acetabular sockets and females is still of utmost importance.
Highlights
An increasing incidence of geriatric acetabular fractures involving the anterior column according to the classification by Judet et al [1] has been recently reported [2]
Age does not have a significant impact on the relation between lateral center–edge angle (LCE) and “residual distance to the femoral head (RD_SFH)” (p value 0.85) and is, not considered
No residual distances below 0 mm were noticed; with decreasing LCE angles, the residual distances increase and vice versa
Summary
An increasing incidence of geriatric acetabular fractures involving the anterior column according to the classification by Judet et al [1] has been recently reported [2]. Fixation of the posterior column remains challenging in acetabular fractures with separation of both columns using a single anterior approach only. Latest fixation techniques related to the management of these fractures include the use of infra-acetabular screw 1, 2) and supra-acetabular screw, which facilitate closure of both columns from anterior [4] This infra-acetabular screw has shown to enhance the fixation strength in these fractures in a biomechanical study [5]. Infra-acetabular screws enhance the fixation strength in acetabular fractures with separation of both columns. Age did not have a significant impact on the relation between LCE and “RD_SFH” (p value 0.85). As hip joint cartilage thickness was not considered in measurements, intraoperative rule-out of screw mispositioning especially in deep acetabular sockets and females is still of utmost importance
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