Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Dec 2019
Fluoroscopically guided acetabular posterior column screw fixation via an anterior approach.
Safe posterior column screw fixation via an anterior approach under two-dimensional fluoroscopic control. ⋯ In a series of 100 pelvic CT scans, the mean posterior angle of the ideal posterior column screw trajectory was 28.0° (range 11.1-46.2°) to the coronal plane and the mean medial angle was 21.6° (range 8.0-35.0°) to the sagittal plane. The maximum screw length was 106.3 mm (range 82.1-135.0 mm). Twelve patients were included in this study: 10 ACPHF and 2 transverse fractures. The residual maximum displacement of the posterior column fracture component in the postoperative CT scan was 1.4 mm (0-4 mm). There was one intraarticular screw penetration and one perforation of the cortical bone in the transition zone between the posterior column and the sciatic tuber without neurological impairment.
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Oper Orthop Traumatol · Dec 2019
Preoperative planning and safe intraoperative placement of iliosacral screws under fluoroscopic control.
Preoperative planning of the starting point and safe trajectory for iliosacral screw (SI screw) fixation using CT scans for safe and accurate fluoroscopically controlled percutaneous SI screw placement. ⋯ Fifty-nine screws were placed in 34 patients using the described technique. There were 2 cases of screw malpositioning (anatomical landmarks inadequately identified and fluoroscopically controlled SI screw fixation should thus not have been performed at all; in a case with sacral dysmorphism, preoperative planning suggested a posterior and/or caudal S1 starting point, respectively, but intraoperatively, selection of a different starting point and screw trajectory resulted in screw malpositioning with iatrogenic L5 nerve palsy).