title: Is application of an internal anterior pelvic fixator anatomically feasible?
abstract: BACKGROUND
  Spinal hardware has been adapted for fixation in the setting of anterior pelvic injury. This anterior subcutaneous pelvic fixator consists of pedicle screws placed in the supraacetabular region connected by a contoured connecting rod placed subcutaneously and above the abdominal muscle fascia.
  
  
  OBJECTIVE
  We examined the placement of the components for anterior subcutaneous pelvic fixator relative to key vascular, urologic, bony, and surface structures.
  
  
  METHODS
  We measured the CT scans of 13 patients after placement of the pelvic fixator to determine the shortest distances between the fixator components and important anatomic structures: the femoral vascular bundle, the urinary bladder, the cranial margin of the hip, the screw insertion point on the bony pelvis, the relationship between the pedicle screw and the corridor of bone in which it resided, and the position relative to the skin.
  
  
  RESULTS
  The average distance from the vascular bundle to the pedicle screw was 4.1 cm and 2.2 cm to the connecting rod. The average distance from the connecting rod to the anterior edge of the bladder was 2.6 cm. The average distance from the screw insertion point to the hip was 2.4 cm; none penetrated the hip. The average screw was in bone for 5.9 cm. The pedicle screws were on average 2.1 cm under the skin. The average distance from the anterior skin to the connecting rod was 2.7 cm.
  
  
  CONCLUSIONS
  Components of this anterior pelvic fixator are close to important anatomic structures. Careful adherence to the surgical technique should minimize potential risk.
  
  
  METHODS
  Level IV, retrospective study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO 63110, USA. davidjmerriman@gmail.com
authors.forename: David J
authors.initials: DJ
authors.lastname: Merriman
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Christopher M
authors.initials: CM
authors.lastname: McAndrew
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D007431:Intraoperative Complications / Q000209:etiology*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies