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The obturator oblique and iliac oblique/outlet views predict most accurately the adequate position of an anterior column acetabular screw

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Abstract

Objective

Percutaneous fixation of the acetabulum is a treatment option for select acetabular fractures. Intra-operative fluoroscopy is required, and despite various described imaging strategies, it is debatable as to which combination of fluoroscopic views provides the most accurate and reliable assessment of screw position.

Materials and methods

Using five synthetic pelvic models, an experimental setup was created in which the anterior acetabular columns were instrumented with screws in five distinct trajectories. Five fluoroscopic images were obtained of each model (Pelvic Inlet, Obturator Oblique, Iliac Oblique, Obturator Oblique/Outlet, and Iliac Oblique/Outlet). The images were presented to 32 pelvic and acetabular orthopaedic surgeons, who were asked to draw two conclusions regarding screw position: (1) whether the screw was intra-articular and (2) whether the screw was intraosseous in its distal course through the bony corridor.

Results

In the assessment of screw position relative to the hip joint, accuracy of surgeon’s response ranged from 52% (iliac oblique/outlet) to 88% (obturator oblique), with surgeon confidence in the interpretation ranging from 60% (pelvic inlet) to 93% (obturator oblique) (P < 0.0001). In the assessment of intraosseous position of the screw, accuracy of surgeon’s response ranged from 40% (obturator oblique/outlet) to 79% (iliac oblique/outlet), with surgeon confidence in the interpretation ranging from 66% (iliac oblique) to 88% (pelvic inlet) (P < 0.0001).

Conclusions

The obturator oblique and obturator oblique/outlet views afforded the most accurate and reliable assessment of penetration into the hip joint, and intraosseous position of the screw was most accurately assessed with pelvic inlet and iliac oblique/outlet views.

Evidence

Clinical Question

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Authors and Affiliations

  1. Orthopedic Trauma Center, National Institute of Traumatology and Orthopedics, Avenida Brasil 500, Rio de Janeiro, RJ, 20940-070, Brazil

    João Antonio Matheus Guimarães & Flávio Ribeiro da Silva

  2. Research Division, National Institute of Traumatology and Orthopedics, Avenida Brasil 500, Rio de Janeiro, RJ, 20940-070, Brazil

    João Antonio Matheus Guimarães, Maria Eugenia Leite Duarte, Amanda dos Santos Cavalcanti & Jamila Alessandra Perini Machado

  3. Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock St, Denver, CO, 80204, USA

    Murphy P. Martin III, Cyril Mauffrey & David Rojas

Authors
  1. João Antonio Matheus Guimarães
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  2. Murphy P. Martin III
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  3. Flávio Ribeiro da Silva
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  4. Maria Eugenia Leite Duarte
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Correspondence to João Antonio Matheus Guimarães.

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Guimarães, J.A.M., Martin, M.P., da Silva, F.R. et al. The obturator oblique and iliac oblique/outlet views predict most accurately the adequate position of an anterior column acetabular screw. International Orthopaedics (SICOT) 43, 1205–1213 (2019). https://doi.org/10.1007/s00264-018-3989-5

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  • DOI: https://doi.org/10.1007/s00264-018-3989-5

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