• Alexander von Glinski, Sven Frieler, Ronen Blecher, Kajsa Mayo, Cara Beth Lee, Emre Yilmaz, Jens R Chapman, Rod J Oskouian, Shane Tubbs, and Thomas A Schildhauer.
• Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, United States. Electronic address: Alexandervonglinski@icloud.com.
• Orthop Traumatol Sur. 2020 Sep 1; 106 (5): 869-875.

BackgroundIncreasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium.HypothesisWe aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries.MethodsTwenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 female, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: Location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition we measured the width of the different bone layers.ResultsThe mean length of the hourglass shaped iliac pillar was 107.04mm with a mean width of 17.0mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o'clock. The smallest mean diameter of the cancellous bone was 7.5mm±2.0.ConclusionThe iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway.Level Of EvidenceAnatomical descriptive study.Copyright © 2020 Elsevier Masson SAS. All rights reserved.

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