Does increased acetabular depth affect safe infra-acetabular screw placement in acetabular fracture fixation?

Bastian, Johannes Dominik; Näf, David Riccardo; Cullmann, Jennifer Larissa; Keel, Marius Johann; Giannoudis, Peter V. (2020). Does increased acetabular depth affect safe infra-acetabular screw placement in acetabular fracture fixation? (In Press). European journal of trauma and emergency surgery Springer-Medizin-Verlag 10.1007/s00068-020-01455-5

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BACKGROUND

Infra-acetabular screws enhance the fixation strength in acetabular fractures with separation of both columns. Placement without iatrogenic femoral head violation is challenging.

PURPOSE

To assess the impact of the acetabular configuration, the patients' age and gender on safe infra-acetabulum screw insertion.

METHODS

In 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.

RESULTS

The 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.

CONCLUSION

The 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Bastian, Johannes Dominik; Cullmann, Jennifer and Keel, Marius

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1863-9933

Publisher:

Springer-Medizin-Verlag

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

31 Jul 2020 15:24

Last Modified:

31 Jul 2020 15:24

Publisher DOI:

10.1007/s00068-020-01455-5

PubMed ID:

32728900

Uncontrolled Keywords:

Acetabulum Depth Fracture Infra-acetabular screw Lateral center–edge–angle Quadrilateral plate

BORIS DOI:

10.7892/boris.145499

URI:

https://boris.unibe.ch/id/eprint/145499

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