Educational Insights on Acetabular Percutaneous Screw Fixation: Posterior and Anterior Column Management in Prone Position

Sepand  Heidari; Negar  Hosseinaei; Mohammadamin Choobdar  Omrani; Seyed Hadi  Kalantar

doi:10.18502/jost.v11i2.18885

Sepand Heidari Resident, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Negar Hosseinaei General Practitioner, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Mohammadamin Choobdar Omrani Resident, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Seyed Hadi Kalantar Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i2.18885

Keywords: Bone Screws; Minimally Invasive Surgical Procedures; Pelvic Bones; Injuries

Abstract

Background: Open reduction and internal fixation (ORIF) of acetabular fractures, while effective, carries significant morbidity. Percutaneous techniques offer reduced soft-tissue damage and blood loss, but require precise radiographic guidance. This study explores the safety and efficacy of prone positioning for percutaneous fixation of both acetabular columns, addressing the lack of data on this approach.

Case Report: A 59-year-old man with a transverse acetabular fracture, classified by Letournel-Judet, underwent percutaneous fixation in the prone position. The procedure involved retrograde posterior column screw placement and antegrade anterior column screw placement. Fluoroscopic imaging was crucial for accurate guide pin and screw insertion, with specific attention to anatomical landmarks and neurovascular structures. The surgical technique details the steps for each screw placement, including fluoroscopic views and potential complications.

Conclusion: Prone positioning for percutaneous acetabular fracture fixation provides excellent surgical access and reliable imaging, and facilitates conversion to open surgery if needed. While prone positioning has limitations, including potential cardiovascular and pulmonary effects, this minimally-invasive technique demonstrated safety and reliability for treating specific acetabular fracture patterns. Preoperative planning and intraoperative imaging are critical for successful outcomes.