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The 2-2-2-20-20 concept for supraacetabular schanz screw insertion without additional radiography.

A M Schwarz1, G M Hohenberger2, P Grechenig3

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Summary

Supra-acetabular Schanz screw insertion can be performed without intraoperative imaging by using a 2-2-2-20-20 anatomical landmark technique. This method ensures accurate screw placement and avoids damage to surrounding nerves and joint capsules.

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Area of Science:

  • Orthopedic Surgery
  • Anatomy
  • Surgical Techniques

Background:

  • Supra-acetabular Schanz screw placement typically requires intraoperative imaging like fluoroscopy.
  • Minimizing radiation exposure and improving surgical efficiency are key goals in orthopedic trauma surgery.

Purpose of the Study:

  • To evaluate the feasibility of inserting supra-acetabular Schanz screws without image intensifier guidance.
  • To test the hypothesis that anatomical landmarks alone are sufficient for accurate screw placement.

Main Methods:

  • The 2-2-2-20-20 technique was applied to 14 Thiel-embalmed cadavers.
  • Schanz screws were inserted 2 cm distal and 2 cm medial to the anterior superior iliac spine (ASIS) with 20° distal and 20° medial angulation.
  • Post-insertion radiographic and CT scans evaluated screw position; dissections assessed for nerve or capsule injury.

Main Results:

  • All 14 Schanz screws were accurately placed within the supra-acetabular corridor, confirmed by radiography and CT scans.
  • Dissections revealed no intra-articular screw placement or injury to the lateral femoral cutaneous nerve (LFCN).

Conclusions:

  • The 2-2-2-20-20 technique allows for safe and accurate supra-acetabular Schanz screw insertion without intraoperative imaging.
  • This landmark-based approach offers a viable alternative to image-guided procedures, potentially reducing radiation exposure and surgical time.