Bishop, J Trauma Acute Care Surg 2012 - Osseous Fixation Pathways in Pelvic and Acetabular Fracture Surgery: Osteology, Radiology, and Clinical Applications

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Osseous Fixation Pathways in Pelvic and Acetabular Fracture Surgery: Osteology, Radiology, and Clinical Applications

Bishop, Routt·J Trauma Acute Care Surg·2012·129 citations·Review article

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Bishop and Routt systematically define pelvic osseous fixation pathways (OFPs) — named corticated bony corridors that accommodate screws for pelvic and acetabular fracture fixation. For each pathway, the paper describes the three-dimensional osteology, the specific fluoroscopic views required to image it safely, and the clinical indications for its use.

Key Findings

The superior pubic ramus OFP is most vulnerable at the iliopsoas gutter and obturator neurovascular sulcus — an anteriorly placed screw can appear intraosseous on both PI and COOO views yet be extraosseous; the cranial-posterior zone is the only reliably safe corridor
Antegrade superior pubic ramus/anterior column screw starting point is 1–2 cm cranial to the acetabulum on the gluteus medius pillar (COOO view); retrograde starting point is at the pubic tubercle zone on PI view
Sacroiliac OFP imaging requires an average of 25° inlet tilt and 60° outlet tilt, but must be individualized — preoperative CT sagittal and scout images allow C-arm angulation to be anticipated before the case
The upper sacral segment typically accommodates two 7-mm cannulated screws; the nondysmorphic second sacral segment has a smaller safe zone and usually fits only one
Eight distinct named OFPs are described (superior pubic ramus/anterior column, inferior pubic ramus, AIIS-to-posterior ilium, gluteus medius pillar, iliac crest, posterior acetabular column, sacroiliac, and trans-iliac trans-sacral), each with its own required fluoroscopic view set and screw sizing recommendations

Osseous Fixation Pathways in Pelvic and Acetabular Fracture Surgery: Osteology, Radiology, and Clinical Applications.

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Osseous Fixation Pathways in Pelvic and Acetabular Fracture Surgery: Osteology, Radiology, and Clinical Applications

Bishop, Routt·J Trauma Acute Care Surg·2012·129 citations·Review article

|

Bishop and Routt systematically define pelvic osseous fixation pathways (OFPs) — named corticated bony corridors that accommodate screws for pelvic and acetabular fracture fixation. For each pathway, the paper describes the three-dimensional osteology, the specific fluoroscopic views required to image it safely, and the clinical indications for its use.

Key Findings

The superior pubic ramus OFP is most vulnerable at the iliopsoas gutter and obturator neurovascular sulcus — an anteriorly placed screw can appear intraosseous on both PI and COOO views yet be extraosseous; the cranial-posterior zone is the only reliably safe corridor
Antegrade superior pubic ramus/anterior column screw starting point is 1–2 cm cranial to the acetabulum on the gluteus medius pillar (COOO view); retrograde starting point is at the pubic tubercle zone on PI view
Sacroiliac OFP imaging requires an average of 25° inlet tilt and 60° outlet tilt, but must be individualized — preoperative CT sagittal and scout images allow C-arm angulation to be anticipated before the case
The upper sacral segment typically accommodates two 7-mm cannulated screws; the nondysmorphic second sacral segment has a smaller safe zone and usually fits only one
Eight distinct named OFPs are described (superior pubic ramus/anterior column, inferior pubic ramus, AIIS-to-posterior ilium, gluteus medius pillar, iliac crest, posterior acetabular column, sacroiliac, and trans-iliac trans-sacral), each with its own required fluoroscopic view set and screw sizing recommendations

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