Extra-articular screw placement strategy in Stoppa approach based on three-dimensional reconstruction model

Area of Science:

• Orthopedic Surgery
• Radiology
• Anatomy

Background:

• The Stoppa approach is a common surgical technique for treating pelvic fractures.
• Accurate screw placement is crucial for successful fixation and avoiding complications.
• Extra-articular screw placement offers potential advantages in certain pelvic fracture scenarios.

Purpose of the Study:

• To investigate and define an optimal extra-articular screw placement strategy for the Stoppa approach.
• To establish anatomical landmarks and safe zones for screw insertion in pelvic fractures.
• To guide surgeons in achieving stable fixation while minimizing intra-articular penetration.

Main Methods:

• Three-dimensional reconstruction of pelvic computed tomography (CT) scans from 2016-2017.
• Identification of key anatomical points (A, B) on the pelvic brim and measurement of distances (a, b, c).
• Analysis of screw lengths for different plate configurations (d, e) across gender and side-specific groups.

Main Results:

• Measurements of distances a, b, and c showed no significant differences between gender and side groups (P > 0.05).
• Safe insertion of three screws in zone 'a' and four screws in zone 'c' was identified.
• Vacant 3-hole drilling in zone 'b' and using fracture lines as landmarks can prevent hip joint penetration.

Conclusions:

• The study provides a validated anatomical guide for extra-articular screw placement in the Stoppa approach.
• Defined zones and screw lengths facilitate safe and effective fixation of pelvic fractures.
• This strategy enhances surgical outcomes by reducing the risk of iatrogenic joint injury.