Axial perspective to find the largest intraosseous space available for percutaneous screw fixation of fractures of the acetabular anterior column

  • XiaoReng Feng
  • JinTao Fang
  • Chaowen Lin
  • Sheng Zhang
  • WenXiong Lei
  • YuanHui Li
  • SanYuan Tang
  • Bin ChenEmail author
Original Article



To find the largest screw path in the acetabular anterior column using a novel method of axial perspective and test the clinical feasibility of the anterior column axial view projection.


3D models with the inner triangular patches deleted were created from the pelvic CT scan data of 58 normal pelvises. The transparency of each 3D model was downgraded at the axial perspective (the view perpendicular to the cross section of the anterior column axis) so that a translucent area was seen clearly. The orientations of each 3D model were adjusted until a triangle-like translucent area that could accommodate the largest virtual screw (Screw I) was present and then an ellipse-like translucent area that could accommodate the two largest virtual screws (Screw II) was present. The maximum diameter, direction of Screw I and the maximum diameter Screw II were measured. Clinical feasibility of the axial view projection was next tested in five cadaveric specimens.


The mean maximum diameters of Screw I and Screw II were \(11.20\,\pm \,1.73\) (7.80–14.60 mm) and \(8.71\,\pm \,0.91\) (6.60–10.60 mm), respectively. The angles of Screw I to the transverse, coronal and sagittal planes were \(41.16^{\circ }\,\pm \,4.59^{\circ }, 18.18^{\circ }\,\pm \,1.15^{\circ }\) and \(44.33^{\circ }\,\pm \,4.31^{\circ }\), respectively. Translucent areas were successfully observed in all the cadaveric hemi-pelves and guide pins were successfully inserted in all the cadaveric hemi-pelves with the assistance of the anterior column axial view projection without cortex penetration or joint violation.


The acetabular anterior column could safely accommodate not only one 7.3-mm screw, but also two 6.5-mm screws. The anterior column axial projection may be clinically feasible.


Acetabular anterior column Percutaneous screw fixation Axial perspective Anterior column axial view projection 



The authors thank Professor Ping Allen Liang for his great contribution to the writing and revising this manuscript. This project was supported by the Natural Science Foundation of China (No. 81401777).

Conflict of interest



  1. 1.
    Attias N, Lindsey RW, Starr AJ, Borer D, Bridges K, Hipp JA (2005) The use of a virtual three-dimensional model to evaluate the intraosseous space available for percutaneous screw fixation of acetabular fractures. J Bone Jt Surg Br 87:1520–1523CrossRefGoogle Scholar
  2. 2.
    Benedetti JA, Ebraheim NA, Xu R, Yeasting RA (1996) Anatomic considerations of plate-screw fixation of the anterior column of the acetabulum. J Orthop Trauma 10:264–272Google Scholar
  3. 3.
    Chang JK, Gill SS, Zura RD, Krause WR, Wang GJ (2001) Comparative strength of three methods of fixation of transverse acetabular fractures. Clin Orthop Relat Res 392:433–441Google Scholar
  4. 4.
    Chen H, Tang P, Yao Y, She F, Wang Y (2014) Anatomical study of anterior column screw tunnels through virtual three-dimensional models of the pelvis. Eur J Orthop Surg Traumatol : Orthop Traumatol 25:105–110Google Scholar
  5. 5.
    Chen KN, Wang G, Cao LG, Zhang MC (2009) Differences of percutaneous retrograde screw fixation of anterior column acetabular fractures between male and female: a study of 164 virtual three-dimensional models. Injury 40:1067–1072Google Scholar
  6. 6.
    Darling AL, Hakim OA, Horton K, Gibbs MA, Cui L, Berry JL, Lanham-New SA, Hart KH (2013) Adaptations in tibial cortical thickness and total volumetric bone density in postmenopausal South Asian women with small bone size. Bone 55:36–43PubMedCrossRefGoogle Scholar
  7. 7.
    Dienstknecht T, Muller M, Sellei R, Nerlich M, Muller FJ, Fuechtmeier B, Berner A (2013) Screw placement in percutaneous acetabular surgery: gender differences of anatomical landmarks in a cadaveric study. Int Orthop 37:673–679PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Ebraheim NA, Xu R, Biyani A, Benedetti JA (1997) Anatomic basis of lag screw placement in the anterior column of the acetabulum. Clin Orthop Relat Res 339:200–205Google Scholar
  9. 9.
    Heeg M, Klasen HJ, Visser JD (1990) Operative treatment for acetabular fractures. J Bone Jt Surg Br 72:383–386Google Scholar
  10. 10.
    Hou Z, Zhang Q, Chen W, Zhang P, Jiao Z, Li Z, Smith WR, Pan J, Zhang Y (2010) The application of the axial view projection of the S1 pedicel for sacroiliac screw. J Trauma 69:122–127PubMedCrossRefGoogle Scholar
  11. 11.
    Mayo KA (1994) Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop Relat Res 305:31–37Google Scholar
  12. 12.
    Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc CH, Fischer JF, Moretti B, Leyvraz PF (2005) Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury 36:1330–1336PubMedCrossRefGoogle Scholar
  13. 13.
    Oransky M, Sanguinetti C (1993) Surgical treatment of displaced acetabular fractures: results of 50 consecutive cases. J Orthop Trauma 7:28–32PubMedCrossRefGoogle Scholar
  14. 14.
    Parker PJ, Copeland C (1997) Percutaneous fluoroscopic screw fixation of acetabular fractures. Injury 28:597–600PubMedCrossRefGoogle Scholar
  15. 15.
    Puchwein P, Enninghorst N, Sisak K, Ortner T, Schildhauer TA, Balogh ZJ, Pichler W (2012) Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion. Arch Orthop Trauma Surg 132:805–811PubMedCrossRefGoogle Scholar
  16. 16.
    Shahulhameed A, Roberts CS, Pomeroy CL, Acland RD, Giannoudis PV (2010) Mapping the columns of the acetabulum—implications for percutaneous fixation. Injury 41:339–342PubMedCrossRefGoogle Scholar
  17. 17.
    Starr AJ, Reinert CM, Jones AL (1998) Percutaneous fixation of the columns of the acetabulum: a new technique. J Orthop Trauma 12:51–58PubMedCrossRefGoogle Scholar

Copyright information

© CARS 2015

Authors and Affiliations

  • XiaoReng Feng
    • 1
  • JinTao Fang
    • 1
  • Chaowen Lin
    • 1
  • Sheng Zhang
    • 1
  • WenXiong Lei
    • 2
  • YuanHui Li
    • 3
  • SanYuan Tang
    • 3
  • Bin Chen
    • 1
    Email author
  1. 1.Department of Orthopedic Trauma, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.Emergency Department, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  3. 3.Department of Orthopaedics and TraumatologyThe People’s Hospital of Zhuhai The Third Hospital Affiliated to Jinan UniversityZhuhaiChina

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