Highlights
- •We evaluated a new technique in application of supraacetabular schanz screws without image intensifier guidance.
- •Respecting the anatomical landmarks, pre- and intraoperative fluoroscopy can be avoided.
- •According to the described anatomical data, we defined a 2–2–2–20–20 concept.
- •Starting with a 2 cm skin incision 2 cm distal and 2 cm medial to the ASIS with a drill angulation of 20° inferior and 20° lateral orientation.
- •Using this technique, all schanz screws could be sufficiently inserted without intraprocedural x-ray imaging.
Abstract
Purpose
Application of supraacetabular Schanz screws is usually performed under image intensifier
guidance. The aim of this study was to perform it without imaging, with the hypothesis
that, respecting anatomical landmarks, pre- and intraoperative fluoroscopy can be
avoided.
Material & Methods
Insertion of the supra-acetabular Schanz screws was performed by two trauma surgery
residents in a study sample of 14 human adult cadavers which had been embalmed by
use of Thiel`s method. With cadavers placed in supine position, the anterior superior
iliac spine (ASIS) was palpated. Starting from this landmark, 2 cm were measured in
a distal and 2 cm in the medial direction. At this point, a 2 cm long oblique skin
incision was performed. Through this approach, 150 mm Schanz screws were drilled bilaterally
into the supra-acetabular corridor with an angulation of 20° to distal as well as
20° to medial. Following screw application, combined obturator oblique-outlet views
(COOO) were taken bilaterally in each specimen by use of an Arcadis© Orbic 3D C-arm
to prove the screw position. Six of the specimens underwent a 3D-CT-scan. Images were
evaluated concerning correct screw positioning by a further traumatologist. Skin and
subcutaneous tissues were removed in the ilioinguinal region and possible lesions
to the lateral femoral cutaneous nerve (LFCN) or to the joint capsule were evaluated.
Results
The sample consisted of eight pelves from female and six pelves from male cadavers.
During radiographic evaluation of the COOO-scans (14 specimens) and the 3D-scans (6
specimens), the Schanz screws were placed inside the supra-acetabular corridor in
all specimens (14/14). During dissections, no intracapsular screw placements or LFCN
lesions were found.
Conclusion
According to the described anatomical data, we defined a 2–2–2–20–20 concept, starting
with a 2 cm skin incision 2 cm distal and 2 cm medial to the ASIS with a drill angulation
of 20° inferior and 20° lateral orientation. Using this technique, all Schanz screws
could be sufficiently inserted without intraprocedural x-ray imaging.
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References
- Apports du fixateur externe dans le disjonctions du pubis and de l'articulation sacro-iliaque.Montpell Chir. 1973; 19: 61-70
- External fixation of double vertical pelvic fractures with a trapezoid compression frame.Inhury. 1978; 10: 142-145
- External fixation in pelvic fractures.Orthop Clin North Am. 1980; 11: 465-479
- Modern concepts of external skeletal fixation of the pelvis.Clin Orthop. 1980; 151: 65-72
- Die Osteosynthese mit dem Fixateur externe am Becken.Arch Orthop Traumat Surg. 1978; 92: 273-283
- Die Indikation externer und interner Stabilisationsverfahren bei der operativen Versorgung der Beckenringfrakturen.Hefte Unfallheilkd. 1984; 164 (Heft): 216-221
- External fixation of the pelvic girdle with a trapezoid compression frame.Injury. 1975; 7: 53-56
- External fixation of unstable pelvic fractures: experiences in 22 patients treated with a trapezoid compression frame.Clin Orthop. 1980; 151: 73-79
- Treatment of pelvic fractures and dislocations.Clin Orthop. 1973; 97: 97-107
- Rockwood C. Green D. Lippincott, Philadelphia1975 (Editors)
- Stabilisierung des Beckenrings mit Fixatuer externe: biomechanische Untersuchungen und klinische Erfahrungen.Orthopäde. 1992; 21: 363-372
- Comperative mechanical performance of some new devices for fixation of unstable pelvic ring fractures.Med & Biol Eng & Comput. 1983; 21: 657-663
- External fixation of unstable pelvic ring fractures: comparative rigidity of some current frame configurations.Med Biol Eng Comput. 1982; 20: 727-733
- Pelvic ring disruption: effective classification systems and treatment protocols.J Trauma. 1990; 30: 848-856
- Pelvic trauma: WSES classification and guidelines.World J Emerg Surg. 2017; https://doi.org/10.1186/s13017-017-0117-6
- The role of angiography in the management of haemorrhage from major fractures of the pelvis.J Bone Joint Surg Br. 2002; 84: 178-182
- Level 3 guideline on the treatment of patients with severe/multiple injuries.Eur J Trauma Emerg Surg. 2018; 44: S3-S271
- Immediate external fixation of unstable pelvic fractures.Am J Surg. 1985; 150: 721-724
- The role of external fixation in pelvic disruptions.Clin Orthop. 1989; 241: 66-82
- Management priorities in patients with polytrauma.Langenbecks Arch Surg. 1998; 383: 220-227
- External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage.J Trauma. 2003; 54: 437-443
- The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition.Crit Care. 2016; 20: 100
- External fixators for pelvic fractures: comparison of the stiffness of current systems.Acta Orthop Scand. 2003; 74: 165-171
- Supraacetabular External Fixation for Pelvic Ring Fractures.Oper Orthop Traumatol. 2005; 17: 296-312
- Eine technische Variante des geschlossenen Fixateur externe am Becken.Z Unfallchir Vers med Berufskr. 1988; 81: 120-125
- Effect of pin location on stability of pelvic external fixation.Clin Orthop. 1999; : 237-244
- Pin placement in pelvic external fixation.Injury. 1993; 24: 581-584
- Anatomic and radiographic considerations in the placement of anterior pelvic external fixator pins.Clin Orthop. 1994; 302: 213-218
- Ergänzung für die Konservierung ganzer Leichen nach W. Thiel.Ann Anat. 2002; 184: 267-269
- Anterior pelvic external fixation: is there an optimal placement for the supra-acetabular pin?.Am J Orthop. 2013; 42: 125-127
- Ultrasound-guided supra-acetabular pin placement in pelvic external fixation: description of a surgical technique and results.Injury. 2017; 48 (Nov): S66-S74https://doi.org/10.1016/S0020-1383(17)30797-0
- Anatomic and radiographic considerations for placement of transiliac screws in lumbopelvic fixations.J Spinal Disord Tech. 2002; 15: 199-205
- Morphometry of the supra sciatic notch intrailiac implant anchor passage.Spine (Phila Pa 1976). 2001; 26: 143-148
- Tscherne unfallchirurgie: becken und acetabulum.Springer-Verlag, Berlin, Heidelberg, New York1998
- Placement of Half-Pins for Supra-acetabular External Fixation: an Anatomic Study.Clin Orthop. 2003; 411: 269-273
- Atlas zur biomechanik der gesunden und kranken hüfte.Springer-Verlag, Berlin Heidelberg New York1973
- Radiological landmarks for the safe extra-capsular placement of supra-acetabular half pins for external fixation.Surg Radiol Anat. 2013; 35 (MarEpub 2012 Sep 9): 131-135https://doi.org/10.1007/s00276-012-1016-x
- Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery.J Orthop Trauma. 1999; 13: 207-211
- Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinguinal surgical dissection.J Orthop Trauma. 1999; 13: 17-19
- An anatomic study of the lateral femoral cutaneous nerve.Surg Radiol Anat. 1997; 19: 307-310
- Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury.Plast Reconstr Surg. 1997; 100: 600-604
- The anatomical variation of the lateral femoral cutaneous nerve in relation to the anterior superior iliac spine and the iliac crest.Musculoskelet Surg. 2010; 94: 17-20
- Variability of the lateral femoral cutaneous nerve: an anatomic basis for planning safe surgical approaches.Clin Anat. 2010; 23: 304-311
- Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement.Surg Radiol Anat. 2009; 31: 199-204
- Relationships of the lateral femoral cutaneous nerve to bony landmarks.Clin Orthop. 2011; 469: 2605-2611
Article info
Publication history
Published online: July 18, 2020
Accepted:
July 18,
2020
Footnotes
☆This paper is part of a supplement supported by The Croatian Trauma Society.
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
