Neurovascular injuries in acetabular reconstruction cage surgery: an anatomical study.
Acetabular reconstruction cages are indicated for severe combined segmental and cavitary acetabular bone defects. The purpose of this study was to evaluate the implications of screw placement and drill plunge and the potential insult to anatomical structures when implanting acetabular reconstruction cages. A segmental cavitary defect was reamed into the acetabulum and a cage was implanted in each of the 10 hemipelvises. The relative course of the superior gluteal neurovascular bundle was mapped to assess dissection intervals. When cage screws were placed at least 15 mm longer than needed, 13% and 20% of screws of the superior flange and anterior rim hit the femoral nerve, respectively, and approximately 60% of the screws placed in the posterior rim endangered the obturator nerve. A "safe zone" for screw size may be a 15- and 25-mm screw for the superior flange and posterior rim, respectively.
Lavernia
Carlos J
CJ
Orthophedic Institute at Mercy Hospital, Miami, Florida 33133, USA.
Cook
Christopher C
CC
Hernandez
Ruben A
RA
Sierra
Rafael J
RJ
Rossi
Mark D
MD
D000077:Acetabulum / Q000473:pathology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D001863:Bone Screws / Q000009:adverse effects; D002102:Cadaver; D005267:Femoral Nerve / Q000293:injuries; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D007084:Iliac Vein / Q000293:injuries; D009776:Obturator Nerve / Q000293:injuries; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods*; D010388:Pelvis / Q000098:blood supply / Q000293:injuries / Q000294:innervation; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors