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Iliac dysmorphism: defining radiographic characteristics and association with pelvic osseous corridor size

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner-outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor.

Methods

Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5 mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured.

Results

The IOTC is an elliptical area measuring 22.3 cm2. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5 mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3 mm in men and 13.8 mm in women (p < 0.001). The gluteal pillar diameter averaged 5.3 mm in men and 4.3 mm in women (p < 0.001).

Discussion

All ilia converge to a thin and frequently unicortical central region. A 4.5 mm iliac wing lag screw will not breach the cortex if it remains within 20 mm or 14 mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5 mm implants.

Conclusion

This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.

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Acknowledgements

We thank Dr. Weston Pack for assisting in statistical analysis of the data, particularly with multivariate analysis.

Funding

No funding was utilized for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University, DUMC Box 104002, Durham, NC, 27710, USA

    Miqi Wang

  2. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave South, R200, Minneapolis, MN, 55454, USA

    Robert C. Jacobs

  3. Department of Orthopaedics & Rehabilitation, University of Vermont, 4th floor Safford Hall, 95 Carrigan Dr., Burlington, VT, 05405, USA

    Craig S. Bartlett & Patrick C. Schottel

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  1. Miqi Wang
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Corresponding author

Correspondence to Miqi Wang.

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Conflict of interest

Craig S. Bartlett is a paid consultant for Stryker and SI Bone. He holds stock in Summate Technology. Patrick C. Schottel is a paid consultant for Synthes. Miqi Wang holds stock in AbbVie Inc. Robert C. Jacobs has nothing to disclose.

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Institutional IRB approval was obtained. No informed consent was required for this retrospective review.

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Wang, M., Jacobs, R.C., Bartlett, C.S. et al. Iliac dysmorphism: defining radiographic characteristics and association with pelvic osseous corridor size. Arch Orthop Trauma Surg 143, 1841–1847 (2023). https://doi.org/10.1007/s00402-022-04376-7

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  • DOI: https://doi.org/10.1007/s00402-022-04376-7

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