Safe zone for transacetabular screw fixation using a Kerboull cross-plate: A CT-scan templating prospective study.
Implantation of Kerboull acetabular reinforcement cross-plates (Kerboull plate) carries a risk for injury to vascular structures and pelvic organs. To our knowledge, there is no study assessing anatomical assessment related to this risk with this specific design. Therefore, we performed a prospective study to answer the following four questions: 1) What is the minimum distance and angle between the plate and iliac vessels? 2) What is the distance between the plate and the inner cortex of the ilium? 3) What is the ratio of views with muscle tissue present on the inner surface of the ilium? 4) What are the boundaries of the safe zone for transacetabular screw fixation for a Kerboull plate?



A safe zone for fixation screws would be defined by a narrow range of insertion angles.



This is a CT-based 3D templating prospective study. Simulations were performed for 18 patients fitted with a Kerboull plate. An original Kerboull plate (Stryker, Mahwah, NJ, USA) was placed at a 45° abduction angle relative to the X-axis (alignment A) and the palette was placed vertically to the X-axis (alignment B). We measured the distance from the centre of the plate to the inner surface of the cortex of the ilium, the shortest distance to vessels and the angle of existing vessels, and the ratio of muscles on the inner surface of the ilium.



The shortest distance to the vascular structures increased with increasing angle of insertion of the fixation screws, 85.8±12.1mm for A and 111.4±12.0mm for B at 45°. The distance to the inner cortex was further increased for screws inserted in posterior direction. At insertion angles ≥40°, the screws passed through muscle before invading the pelvis in most cases. However, at anterior-posterior angle (AP angles) ≤-10°, the risk of direct insertion of screws into the sacroiliac joint increased.



The safe zone for transacetabular screws would be insertion at an angle≥40°, with an AP angle between 0° and -10° (slight posterior direction).



Level IV prospective diagnostic study.
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, 920-8641 Kanazawa Ishikawa Japan.
T
T
Ohmori
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, 920-8641 Kanazawa Ishikawa Japan. Electronic address: tamonkabata@yahoo.co.jp.
T
T
Kabata
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, 920-8641 Kanazawa Ishikawa Japan.
Y
Y
Kajino
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, 920-8641 Kanazawa Ishikawa Japan.
K
K
Hasegawa
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, 920-8641 Kanazawa Ishikawa Japan.
D
D
Inoue
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, 920-8641 Kanazawa Ishikawa Japan.
H
H
Tsuchiya
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws / Q000009:adverse effects; D003198:Computer Simulation; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000293:injuries; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000293:injuries; D007085:Ilium / Q000000981:diagnostic imaging; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012446:Sacroiliac Joint / Q000293:injuries; D014057:Tomography, X-Ray Computed
CT-based 3D templating; Kerboull acetabular reinforcement cross-plate; Nerve lesions; Optimal length of screws; Safe zone; Vascular lesions