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SYMPOSIUM Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 1  |  Page : 20-21
Implant selection and placement in acetabular fractures


Department of Orthopaedics, LTM Medical College & Hospital, Mumbai., India

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How to cite this article:
Ganorkar S, Thacker M, Thacker C J. Implant selection and placement in acetabular fractures. Indian J Orthop 2002;36:20-1

How to cite this URL:
Ganorkar S, Thacker M, Thacker C J. Implant selection and placement in acetabular fractures. Indian J Orthop [serial online] 2002 [cited 2019 Dec 14];36:20-1. Available from: http://www.ijoonline.com/text.asp?2002/36/1/20/35918
The innominate bone is a mass of strong corticocancellous bone. Except for very old and infirm persons, the quality of bone is excellent, and hence fixation with screws and plates gives adequate stabilization. Different modes of fixation viz. interfragmentary screw fixation, neutralisation plate, buttress plate, circlage wire [1] are used depending on the fracture geometry.

Depending on the size of the fragments, 4mm cancellous screws, 4.5mm cortical screws or 6.5mm cancellous screws may be used. After achieving primary interfragmentary compression, neutralization using a reconstruction plate is recommended.

The following fractures can easily be fixed with interfragmentary screw fixation:

  • Large posterior lip fracture [Figure 1]
  • Posterior column fracture [Figure 2]
  • Low anterior column fracture [Figure 3(a)]
  • Iliac wing fracture [Figure 3(b)]
  • Transverse fracture
  • T shaped fracture
  • Certain components of complex both column fractures


If the surface area of the fragments is large, one or two interfragmentary screws may be used. This may be achieved through a limited approach.

To prevent implant failure, the reduction should be anatomic and the implant must achieve compression at the fracture site. Thorough knowledge of anatomy is essential to prevent complications like joint penetration and injury to neuro-vascular bundles. Proper principles of lag screw fixation must be followed for a firm bone purchase.

It is also important to select the screw of appropriate dimension to avoid failure. If too thin a screw is used there is always a risk of fatigue failure, while a screw too thick, could cause an iatrogenic fracture during introduction.

4mm cancellous screws may be used for posterior lip fractures and 6.5mm cancellous screws may be used for the columns. It is possible to use 3.5mm or 4.5mm cortical screws as interfragmentary screw through a proper gliding hole. 4mm screws may also be used to fix fractures of the pubis and the iliac wing. 4.5mm screws can be used for fixation of anterior column through posterior approach.

6.5mm screws are reserved for posterior column fixation through anterior approach. [2] 6.5 mm screws must be used with caution in Indian patients and it may be prudent to use 4.5mm screws when in doubt.

One may require screws upto 80mm in length; hence it is essential to have long drill bits, depth gauge and suitable taps readily available. To ensure that the screw is not transfixing the joint, move the hip joint through full range after insertion of each screw. Imaging or x-ray is mandatory.

Buttress plate: This method of fixation is useful especially in cases of comminution of the quadrilateral plate. [1] Since the area of the quadrilateral plate is very thin and not amenable to direct fixation, a contoured radius T plate may be used to buttress this important area, to prevent central migration of the femoral head [Figure 4].

 
   References Top

1.Tile M. Fractures of Pelvis and acetabulum. Baltimore; Williams & Wilkins, 1984.  Back to cited text no. 1    
2.Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach : A 10 year perspective. Clin Orthop 1994; 305:10-19.  Back to cited text no. 2    

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Correspondence Address:
S Ganorkar
, Fracture Treatment Centre, Behind Mahamarg Bus Stand, Nashik
India
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Source of Support: None, Conflict of Interest: None


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    Figures

  [Figure 1], [Figure 2], [Figure 4]



 

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