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

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 be-tween 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 differ-ence 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 pre-dicts 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 dif-ference in the average sagittal insertion angle of PCs, which was 38.3 & DEG; in the control group and 27.2 & DEG; 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.(c) 2022 Elsevier Ltd. All rights reserved.

Automated summary

This study reveals the impact of pelvic dysmorphism on the insertion angle and entry point of aPCS in acetabular fracture treatment. Dysmorphic pelvises require a more acute angular trajectory for aPCS insertion. The lack of such studies may lead to increased difficulty during surgery and risks of complications.