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The difference in the corridor of the antegrade posterior column screw according to the presence of pelvic dysmorphism

Authors
Lim, Eic JuSakong, SeungyeobChoi, WonseokChung, Dong MinSon, Whee SungKim, HanJuOh, Jong-KeonJang, Jae HoonCho, Jae-Woo
Issue Date
Nov-2022
Publisher
Elsevier BV
Keywords
Acetabulum; Pelvic dysmorphism; Posterior column screw; Internal fixation; Fracture
Citation
Injury, v.53, no.11, pp 3774 - 3780
Pages
7
Indexed
SCIE
SCOPUS
Journal Title
Injury
Volume
53
Number
11
Start Page
3774
End Page
3780
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61877
DOI
10.1016/j.injury.2022.08.056
ISSN
0020-1383
1572-3461
Abstract
Introduction Antegrade posterior column screw (aPCS) fixation via the anterior approach has been widely used for separated the posterior columns in acetabular fracture treatment. Although the relationship between pelvic dysmorphism and sacroiliac screws has been widely studied, no studies have reported on the clinical impact of pelvic dysmorphism on acetabular fractures. This study aimed to reveal the difference in the insertion angle and entry point of aPCS between the dysmorphic and normal pelvises. Methods Patients diagnosed with unilateral acetabular fractures and who underwent pelvic computed tomography scans between 2013 and 2019 in two institutes were enrolled in this study. Patients were divided into the dysmorphic and control groups according to the sacral dysmorphic score, which predicts the presence of pelvic dysmorphism, and each group enrolled 130 patients. The semitransparent 3D hemipelvis model was reconstructed using a 3D reconstruction program. The sagittal and coronal angles of a virtual cylinder that fill the safe corridor of the column screw the most were measured. The surface area of the safe corridor and distance of the optimal entry point from the anterior border of the sacroiliac joint were analyzed. The measurements were compared between the dysmorphic and control groups. Results The average sacral dysmorphic score in the normal and dysmorphic pelvis groups was 56.1 and 81.0, respectively. There were no significant differences in demographic data, including age, sex, height, weight, and body mass index, between the dysmorphic and control groups. There was a significant difference in the average sagittal insertion angle of PCs, which was 38.3° in the control group and 27.2° in the dysmorphic group (P < 0.001). The coronal insertion angles were not significantly different. The dysmorphic group presented longer straight distances (25.9 vs 24.8 mm, P = 0.026) and had a smaller aPCS surface area (685 vs 757 mm2, P < 0.001) than the control group. Conclusion The present study describes a difference in the corridor of aPCS between the dysmorphic and normal pelvis. Insertion of aPCS in the dysmorphic pelvis requires a more acute angular trajectory in the sagittal plane than that in the normal pelvis.
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Choi, Won seok
Guro Hospital (Department of Orthopedic Surgery, Guro Hospital)
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