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Updated: Jun 26, 2026

A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
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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
PubMed
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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.

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.