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Anatomic study for pubic medullary screw insertion.

T Suzuki¹, K Soma, M Shindo

¹Department of Traumatology and Emergency Medicine, Kitasato University School of Medicine, Sagamihara, Japan. takashisuzuki911@yahoo.co.jp

Journal of Orthopaedic Surgery (Hong Kong)

|January 8, 2009

Summary

Safer pubic screw fixation requires careful anatomical study. This research highlights risks like joint penetration and iliac vein injury, recommending alternative methods for narrow acetabular canals.

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Area of Science:

Orthopedic surgery
Anatomy
Medical imaging

Background:

Pubic screw fixation is a common orthopedic procedure.
Understanding the precise anatomy of the pubic ramus and surrounding structures is crucial for safe screw placement.
Previous studies have not fully detailed the anatomical variations relevant to retrograde pubic screw insertion in the Japanese population.

Purpose of the Study:

To investigate the detailed anatomy of the pubic ramus and adjacent vital structures in a Japanese cohort.
To establish anatomical parameters for a safer and more effective pubic screw fixation technique.
To identify potential risks associated with pubic screw placement and propose mitigation strategies.

Main Methods:

A retrospective analysis of 160 Japanese individuals (80 male, 80 female) aged 16-89 years.

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Three-dimensional computed tomographic (3D-CT) scanning of the pelvis was performed.

Measurements included screw trajectory angles, screw length, canal diameter, and distances to the bladder, iliac artery, and iliac vein.

Main Results:

Mean screw length was approximately 124 mm for men and 123.8 mm for women.
Optimal screw insertion angles were determined (e.g., 66-67° cephalad, 54-56° laterally).
Critical minimum distances to the bladder (0 mm), iliac artery (4.6-4.9 mm), and iliac vein (0.2-0.8 mm) were recorded. Canal diameters correlated with weight and height in specific areas.

Conclusions:

Pubic screw fixation carries risks of joint penetration and iliac vein injury, necessitating cautious application.
Alternative fixation methods such as plate fixation or computer-assisted surgery are recommended for cases with narrow acetabular canals.
Precise anatomical knowledge is essential to minimize complications during pubic screw fixation.