The retroacetabular angle determines the safe angle for screw placement in posterior acetabular fracture fixation

Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15-74) years. The average (range) retroacetabular angle was 39 (30-47) degrees. The average (range) retroacetabular tangent was 36 (30-45) mm. Conclusions. Placing the screws at an average (range) angle of 39 (33-47) degrees of anterior inclination with the retroacetabular surface makes them extraarticular. Angles for medial screws are larger. Safe angles can be calculated preoperatively with a computer program.