Surgical Drill Guide for Insertion of an Infra-Acetabular Screw Based on an Anatomically Precontoured Plate System: A Cadaveric Study.

Viola Freigang,Stephan Grechenig,Volker Alt,Markus Rupp,Florian Baumann,Christian Pfeifer,Maximilian Gottsauner,Alexander Kerner

doi:10.1155/2021/2321504

Viola Freigang, Stephan Grechenig + Show 6 more

Open Access

https://doi.org/10.1155/2021/2321504

Copy DOI

Abstract

Purpose Due to the anatomic structure of the pelvis, free-hand placement of screws in the acetabular fracture management can be difficult. Infra-acetabular screw fixation increases acetabular stability by distal fixation of the cup. Aim of this cadaveric study is to investigate if a plate-referenced drill guide can provide save placement of an infra-acetabular screw over a precontoured suprapectineal quadrilateral buttress plate (SQBP). Methods We constructed a drill guide for an infra-acetabular screw based on the surface of an anatomically precontoured SQBP. A total of 12 adult cadaveric acetabular specimens were used for drill guide-assisted placement of the infra-acetabular screw. The drill guide contains a radiopaque spiral to allow longitudinal fine adjustment of the SQBP along the pelvic brim to assure correct position of the plate-drill-guide construct in relation to the Koehler's teardrop. After screw placement, we conducted a computed tomography (CT) scan of all specimens to assess the actual position of the screw in relation of the infra-acetabular corridor and the acetabular joint surface. Results The position of the screw was within the infra-acetabular corridor in all cases. We did not see any intra-articular or intrapelvic screw penetration. The mean distance of the centerline of the screw to the medial border of the infra-acetabular corridor was 3.35 mm. The secure distance to the virtual surface of the femoral head to was 7.3 mm. Conclusions A plate-referenced drill guide can provide safe placement of an infra-acetabular screw for treatment of acetabular fractures. Radiographic fine adjustment is necessary to access the optimal entry point.

Highlights

Due to the anatomic situation of the pelvis and acetabulum, management of an acetabular fracture is a technically demanding procedure
A dissociation of the anterior column to the posterior column followed by a medialization of the quadrilateral surface has been identified as a risk factor for a secondary dislocation leading to a so called “central subluxation” of the femoral head [2,3,4]
The purpose of the study is to investigate if a platereferenced drill guide can provide save placement of an infra-acetabular screw over a precontoured suprapectineal quadrilateral buttress plate (SQBP)

Summary

Introduction

Due to the anatomic situation of the pelvis and acetabulum, management of an acetabular fracture is a technically demanding procedure. The close relationship to the iliac vessels and the complex construction of the acetabulum make it challenging to achieve reduction and fixation of the anterior and posterior acetabular column. Large registry-based epidemiologic studies have demonstrated a rising number of acetabular fractures involving the anterior column over the last 20 years [1]. Precontoured plate systems can provide enhanced reduction and fixation properties [10, 11]. Plate systems with a buttress to support the quadrilateral surface provide increased periacetabular stability [11,12,13,14]

Objectives

Methods

Results

Discussion

Conclusion