Injury
-
Percutaneous retrograde screw fixation of the anterior column has been recommended for the treatment of minimally displaced acetabular fractures. However, proper placement of the screw in anterior column is challenging because of its unique anatomy. There are few anatomic studies on this technique, and the differences between male and female have never been reported. ⋯ The anterior column of a male will accommodate a 6.5mm lag screw very well, but it does not fit all the females. The same direction of screw can be used in both male and female, but the insertion points of the screw are different. In addition, the determination of the size of the screw used for the anterior column cannot be based solely on the measurement of cross-sectional diameter and the virtual three-dimensional reconstruction model might be useful in preoperative planning.
-
In order to reduce the incidence of cut-out, which is one of the serious postoperative complications of trochanteric femoral fractures, we paid special attention to the placement of lag screw in the femoral head. As a result, we devised a new technique that allows insertion of the lag screw at the first attempt into the optimal position on both planes, inferior half on the antero-posterior view and exactly central on the lateral view, without the need for any special devices other than the basic original set, using a trochanteric nail. For this technique, we have evaluated the proximal femoral profile under image intensifier, on the true lateral view projected parallel to the axis of the femoral neck and not on the conventional lateral view (Lauenstein view) with the projection parallel to the axis of the femoral shaft in a coronal plane. ⋯ The mean deviation angle of 1.6 degrees in the 39 fractures after the introduction of the new insertion technique was compared with 4.8 degrees in the 44 fractures before the introduction, which showed a significant difference between these groups (p<0.0001, Welch's t-test). When the lag screw can be placed exactly in the centre of the femoral head on the true lateral view, it can be set forward as closest to articular surfaces as possible on the postero-anterior view without a risk of penetration, so that the tip-apex distance could be easily achieved under 20mm, which leads to a reduction of postoperative cut-outs. This technique can be applied in other similar trochanteric nails, which gives them an advantage over the sliding hip screws.