A safe technique of anterior column lag screw fixation in acetabular fractures

Ramesh Kumar Sen, Sujit Kumar Tripathy, Sameer Aggarwal, Tarun Goyal, Dharm S. Meena, Santosh Mahapatra

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: Conventional anterior column lag screw fixation in acetabular fracture is a difficult technique that has potential risks of vascular injury, hip joint penetration and excessive radiation exposure. We propose a safe technique of anterior column lag screw fixation (in-out-in technique) and present the outcome. Materials and methods: Twenty-seven acetabular fractures were operated through an iliofemoral approach, where the 'in-out-in technique' of lag screw fixation was a part of the surgical procedure. The technique involved insertion of a malleolar screw (4.5 mm) or 6.5 mm partially threaded cancellous screw from the outer side of the iliac wing, 0.5-1 cm posterior and inferior to the anteroinferior iliac spine. The screw comes out of the bone surface to re-enter into the anterior part of iliopectineal eminence, and finally gains purchase in the lateral part of superior pubic ramus. The screw fixation procedure was under direct visualization without resorting to an image intensifier. The average follow-up of the patients was at 18.6 months (range 12-36 months). Results: No loss of reduction, joint penetration or visceral and neurovascular injury were documented. The average duration of surgery was 70 min and blood loss was 290 ml. All fractures were united after an average period of 2.8 months. Excellent to good functional outcome was observed in 24 patients (88 %), on evaluation with Merle D'Aubigne and Postel score at the latest follow-up. Conclusion: We conclude that the 'in-out-in technique' is a safe and effective method of anterior column lag screw fixation in acetabular fractures. It provides rigid stability and minimizes surgical duration, radiation exposure and intra-operative complications.

Original languageEnglish
Pages (from-to)2333-2340
Number of pages8
JournalInternational Orthopaedics
Volume36
Issue number11
DOIs
Publication statusPublished - 01-11-2012
Externally publishedYes

Fingerprint

Vascular System Injuries
Hip Joint
Spine
Joints
Bone and Bones
Wounds and Injuries
Radiation Exposure

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

Sen, R. K., Tripathy, S. K., Aggarwal, S., Goyal, T., Meena, D. S., & Mahapatra, S. (2012). A safe technique of anterior column lag screw fixation in acetabular fractures. International Orthopaedics, 36(11), 2333-2340. https://doi.org/10.1007/s00264-012-1661-z
Sen, Ramesh Kumar ; Tripathy, Sujit Kumar ; Aggarwal, Sameer ; Goyal, Tarun ; Meena, Dharm S. ; Mahapatra, Santosh. / A safe technique of anterior column lag screw fixation in acetabular fractures. In: International Orthopaedics. 2012 ; Vol. 36, No. 11. pp. 2333-2340.
@article{c506865f219947c1957b5187ed99fd0a,
title = "A safe technique of anterior column lag screw fixation in acetabular fractures",
abstract = "Purpose: Conventional anterior column lag screw fixation in acetabular fracture is a difficult technique that has potential risks of vascular injury, hip joint penetration and excessive radiation exposure. We propose a safe technique of anterior column lag screw fixation (in-out-in technique) and present the outcome. Materials and methods: Twenty-seven acetabular fractures were operated through an iliofemoral approach, where the 'in-out-in technique' of lag screw fixation was a part of the surgical procedure. The technique involved insertion of a malleolar screw (4.5 mm) or 6.5 mm partially threaded cancellous screw from the outer side of the iliac wing, 0.5-1 cm posterior and inferior to the anteroinferior iliac spine. The screw comes out of the bone surface to re-enter into the anterior part of iliopectineal eminence, and finally gains purchase in the lateral part of superior pubic ramus. The screw fixation procedure was under direct visualization without resorting to an image intensifier. The average follow-up of the patients was at 18.6 months (range 12-36 months). Results: No loss of reduction, joint penetration or visceral and neurovascular injury were documented. The average duration of surgery was 70 min and blood loss was 290 ml. All fractures were united after an average period of 2.8 months. Excellent to good functional outcome was observed in 24 patients (88 {\%}), on evaluation with Merle D'Aubigne and Postel score at the latest follow-up. Conclusion: We conclude that the 'in-out-in technique' is a safe and effective method of anterior column lag screw fixation in acetabular fractures. It provides rigid stability and minimizes surgical duration, radiation exposure and intra-operative complications.",
author = "Sen, {Ramesh Kumar} and Tripathy, {Sujit Kumar} and Sameer Aggarwal and Tarun Goyal and Meena, {Dharm S.} and Santosh Mahapatra",
year = "2012",
month = "11",
day = "1",
doi = "10.1007/s00264-012-1661-z",
language = "English",
volume = "36",
pages = "2333--2340",
journal = "International Orthopaedics",
issn = "0341-2695",
publisher = "Springer Verlag",
number = "11",

}

Sen, RK, Tripathy, SK, Aggarwal, S, Goyal, T, Meena, DS & Mahapatra, S 2012, 'A safe technique of anterior column lag screw fixation in acetabular fractures', International Orthopaedics, vol. 36, no. 11, pp. 2333-2340. https://doi.org/10.1007/s00264-012-1661-z

A safe technique of anterior column lag screw fixation in acetabular fractures. / Sen, Ramesh Kumar; Tripathy, Sujit Kumar; Aggarwal, Sameer; Goyal, Tarun; Meena, Dharm S.; Mahapatra, Santosh.

In: International Orthopaedics, Vol. 36, No. 11, 01.11.2012, p. 2333-2340.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A safe technique of anterior column lag screw fixation in acetabular fractures

AU - Sen, Ramesh Kumar

AU - Tripathy, Sujit Kumar

AU - Aggarwal, Sameer

AU - Goyal, Tarun

AU - Meena, Dharm S.

AU - Mahapatra, Santosh

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Purpose: Conventional anterior column lag screw fixation in acetabular fracture is a difficult technique that has potential risks of vascular injury, hip joint penetration and excessive radiation exposure. We propose a safe technique of anterior column lag screw fixation (in-out-in technique) and present the outcome. Materials and methods: Twenty-seven acetabular fractures were operated through an iliofemoral approach, where the 'in-out-in technique' of lag screw fixation was a part of the surgical procedure. The technique involved insertion of a malleolar screw (4.5 mm) or 6.5 mm partially threaded cancellous screw from the outer side of the iliac wing, 0.5-1 cm posterior and inferior to the anteroinferior iliac spine. The screw comes out of the bone surface to re-enter into the anterior part of iliopectineal eminence, and finally gains purchase in the lateral part of superior pubic ramus. The screw fixation procedure was under direct visualization without resorting to an image intensifier. The average follow-up of the patients was at 18.6 months (range 12-36 months). Results: No loss of reduction, joint penetration or visceral and neurovascular injury were documented. The average duration of surgery was 70 min and blood loss was 290 ml. All fractures were united after an average period of 2.8 months. Excellent to good functional outcome was observed in 24 patients (88 %), on evaluation with Merle D'Aubigne and Postel score at the latest follow-up. Conclusion: We conclude that the 'in-out-in technique' is a safe and effective method of anterior column lag screw fixation in acetabular fractures. It provides rigid stability and minimizes surgical duration, radiation exposure and intra-operative complications.

AB - Purpose: Conventional anterior column lag screw fixation in acetabular fracture is a difficult technique that has potential risks of vascular injury, hip joint penetration and excessive radiation exposure. We propose a safe technique of anterior column lag screw fixation (in-out-in technique) and present the outcome. Materials and methods: Twenty-seven acetabular fractures were operated through an iliofemoral approach, where the 'in-out-in technique' of lag screw fixation was a part of the surgical procedure. The technique involved insertion of a malleolar screw (4.5 mm) or 6.5 mm partially threaded cancellous screw from the outer side of the iliac wing, 0.5-1 cm posterior and inferior to the anteroinferior iliac spine. The screw comes out of the bone surface to re-enter into the anterior part of iliopectineal eminence, and finally gains purchase in the lateral part of superior pubic ramus. The screw fixation procedure was under direct visualization without resorting to an image intensifier. The average follow-up of the patients was at 18.6 months (range 12-36 months). Results: No loss of reduction, joint penetration or visceral and neurovascular injury were documented. The average duration of surgery was 70 min and blood loss was 290 ml. All fractures were united after an average period of 2.8 months. Excellent to good functional outcome was observed in 24 patients (88 %), on evaluation with Merle D'Aubigne and Postel score at the latest follow-up. Conclusion: We conclude that the 'in-out-in technique' is a safe and effective method of anterior column lag screw fixation in acetabular fractures. It provides rigid stability and minimizes surgical duration, radiation exposure and intra-operative complications.

UR - http://www.scopus.com/inward/record.url?scp=84876587828&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876587828&partnerID=8YFLogxK

U2 - 10.1007/s00264-012-1661-z

DO - 10.1007/s00264-012-1661-z

M3 - Article

C2 - 23001195

AN - SCOPUS:84876587828

VL - 36

SP - 2333

EP - 2340

JO - International Orthopaedics

JF - International Orthopaedics

SN - 0341-2695

IS - 11

ER -

Sen RK, Tripathy SK, Aggarwal S, Goyal T, Meena DS, Mahapatra S. A safe technique of anterior column lag screw fixation in acetabular fractures. International Orthopaedics. 2012 Nov 1;36(11):2333-2340. https://doi.org/10.1007/s00264-012-1661-z