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Percutaneous Fixation of Anterior Column Fx

 

- See: Classification and Column Theory

- Percutaneous Screw Placement:
    - anterior column screws can be placed either antegrade (from cephalad to caudad) or retrograde (vice versa);
    - implant: 7.3 or 8.0 mm cannulated screws;
    - C-arm is placed perpendicular to the superior pubic ramus;
         - inlet iliac view: helps to avoid guide wire penetration of the inner cortex of the superior ramus;
         - outlet-obturator oblique view: helps to avoid guide wire penetration of the hip joint;
    - antegrade insertion:
         - used when the patient is in the lateral or supine position;
         - starting  point is 4-5 cm back from the ASIS;
         - guide pin is driven down into the superior ramus using the inlet-iliac oblique (to ensure that the guide wire does not penetrate the
                 inner pubic ramus cortex) and the inlet-obturator oblique view ( to ensure that the guide pin does not penetrate into the hip);
    - retrograde insertion:
         - only used when the patient is in the supine position;
         - difficult insertion when the patient is obese;
         - use a 3 cm mini Pfannenstiel incision;
         - guide pin is directed into the affected side pubic tubercle;
               - guide pin is directed to a point posterior and inferior to the ASIS;
               - guide pin is directed up into the superior ramus using the inlet-iliac oblique (to ensure that the guide wire does not penetrate the inner
                        pubic ramus cortex) and the inlet-obturator oblique view ( to ensure that the guide pin does not penetrate into the hip)



Anterior column fractures of the acetabulum.

Anatomic considerations of plate-screw fixation of the anterior column of the acetabulum.

Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results.

Percutaneous fixation of the columns of the acetabulum: a new technique.

Percutaneous fixation of anterior column acetabular fractures--first experience

Axial view of acetabular anterior column: a new X-ray projection of percutaneous screw placement

- PreOp Planning: