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Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

  • Basic Research
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Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 22 October 2014

Abstract

Background

An infraacetabular screw path facilitates the closure of a periacetabular fixation frame to increase the plate fixation strength in acetabular fractures up to 50%. Knowledge of the variance in corridor sizes and axes has substantial surgical relevance for safe screw placement.

Questions/purposes

(1) What proportion of healthy pelvis specimens have an infraacetabular corridor that is 5 mm or larger in diameter? (2) Does a universal corridor axis and specific screw entry point exist? (3) Are there sex-specific differences in the infraacetabular corridor size or axis and are these correlated with anthropometric parameters like age, body weight and height, or the acetabular diameter?

Methods

A template pelvis with a mean shape from 523 segmented pelvis specimens was generated using a CT-based advanced image analyzing system. Each individual pelvis was registered to the template using a free-form registration algorithm. Feasible surface regions for the entry and exit points of the infraacetabular corridor were marked on the template and automatically mapped to the individual samples to perform a measurement of the maximum sizes and axes of the infraacetabular corridor on each specimen. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5-mm cortical screw in clinical settings.

Results

In 484 of 523 pelves (93%), an infraacetabular corridor with a diameter of at least 5 mm was found. Using the mean axis angulations (54.8° [95% confidence interval {CI}, 0.6] from anterocranial to posterocaudal in relation to the anterior pelvic plane and 1.5° [95% CI, 0.4] from anteromedial to posterolateral in relation to the sagittal midline plane), a sufficient osseous corridor was present in 64% of pelves. Allowing adjustment of the three-dimensional axis by another 5° included an additional 25% of pelves. All corridor parameters were different between females and males (corridor diameter, 6.9 [95% CI, 0.2] versus 7.7 [95% CI, 0.2] mm; p < 0.001; corridor length, 96.2 [95% CI, 0.7] versus 106.4 [95% CI, 0.6] mm; p < 0.001; anterior pelvic plane angle, 54.0° [95% CI, 0.9] versus 55.3° [95% CI, 0.8]; p < 0.01; sagittal midline plane angle, 4.3° [95% CI, 0.6] versus −0.3° [95% CI, 0.5]; p < 0.001).

Conclusion

This study provided reference values for placement of a 3.5-mm cortical screw in the infraacetabular osseous corridor in 90% of female and 94% of male pelves. Based on the sex-related differences in corridor axes, the mean screw trajectory is approximately parallel to the sagittal midline plane in males but has to be tilted from medial to lateral in females. Considering the narrow corridor diameters, we suggest an individual preoperative CT scan analysis for fine adjustments in each patient.

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Acknowledgments

We thank Dr Jürgen Schwarz for help with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Trauma-, Hand- and Reconstructive Surgery, Friedrich-Schiller University, Jena, Erlanger Allee 101, 07740, Jena, Germany

    Florian Gras PD Dr med & Ivan Marintschev DM

  2. Clinic of Orthopaedics and Sportsorthopaedics, Klinikum r.d. Isar, Technische Universität München, Munich, Germany

    Heiko Gottschling Dr rer nat, Manuel Schröder Dipl Inf & Rainer Burgkart PD Dr med

  3. Stryker Trauma GmbH, Schoenkirchen/Kiel, Germany

    Nils Reimers MBE

Authors
  1. Florian Gras PD Dr med
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  2. Heiko Gottschling Dr rer nat
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  3. Manuel Schröder Dipl Inf
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  4. Ivan Marintschev DM
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  5. Nils Reimers MBE
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  6. Rainer Burgkart PD Dr med
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Corresponding author

Correspondence to Florian Gras PD Dr med.

Additional information

One of the authors (NR) is an employee of Stryker Trauma GmbH, Kiel, Germany.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Friedrich-Schiller University, Jena, Germany, and the Klinikum r.d. Isar, Technische Universität in München, Munich, Germany.

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Gras, F., Gottschling, H., Schröder, M. et al. Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves. Clin Orthop Relat Res 473, 361–369 (2015). https://doi.org/10.1007/s11999-014-3932-z

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