Measurement of the “Safe Zone” and the “Dangerous Zone” for the Screw Placement on the Quadrilateral Surface in the Treatment of Pelvic and Acetabular Fractures with Stoppa Approach by Computational 3D Technology

Sheng Zhang,Bin Chen,Qiang Luo,Wanhan Su,Frankie Leung

doi:10.1155/2014/386950

Sheng Zhang, Bin Chen + Show 3 more

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https://doi.org/10.1155/2014/386950

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Abstract

This study is aimed at definition of the safe and dangerous zone for screw placement with Stoppa approach for rapid identification during operation and a new way for the studies on the “safe zone.” Pelvic CT data of 84 human subjects were recruited to reconstruct the three-dimensional (3D) models. The distances between the edges of the “safe zone,” “dangerous zone,” and specific anatomic landmarks such as the obturator canal and the pelvic brim were precisely measured, respectively. The results show that the absolute “dangerous zone” was from the pelvic brim to 3.07 cm below it and within 2.86 cm of the obturator canal, while the region 3.56 cm below the pelvic brim or 3.85 cm away from the obturator canal was the absolute “safe zone” for screw placement. The region between the absolute “safe zone” and the absolute “dangerous zone” was the relatively “dangerous zone.” As a conclusion, application of computer-assisted 3D modeling techniques aids in the precise measurement of “safe zone” and “dangerous zone” in combination with Stoppa incision. It was not recommended to place screws on the absolute dangerous zone, while, for the relatively “dangerous zone,” it depends on the individual variations in bony anatomy and the fracture type.

Highlights

Surgery and secured internal fixation are required for the majority of pelvic and acetabular fractures with displacement to achieve an anatomical reduction and a good prognosis [1]
The anterior ilioinguinal approach reported by Matta [2] and stockle et al [3] is most commonly used in treating patients with pelvic and acetabular fractures
The purpose of this study is to identify the “dangerous zone” quickly and precisely during a surgery, and try to provide references for safe screw placement and a new way for the studies on the “safe zone.”

Summary

Introduction

Surgery and secured internal fixation are required for the majority of pelvic and acetabular fractures with displacement to achieve an anatomical reduction and a good prognosis [1]. Due to the fact that three exposure windows are required for this procedure, it may increase the difficulty of the surgery, and inner fixation of screws on the quadrilateral surface is difficult. Good outcomes using the modified Stoppa approach for treating pelvic and acetabular fractures were obtained, which was first reported by Cole and Bolhofner [5] and was followed by Ponsen et al [6], Andersen et al [7], and Archdeacon et al [8] In many cases, a plate has to be placed on the quadrilateral surface. Identification of danger zones where screws are at high risk of penetrating into the articular surface is essential for the success of this procedure

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