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Article
Gun Barrel View of the Anterior Pelvic Ring for Percutaneous Anterior Column or Superior Pubic Ramus Screw Placement
European Journal of Orthopaedic Surgery and Traumatology
  • Nicholas Quercetti, III
  • Brandon R. Horne, Wright State University
  • Zachary J Dipaolo, Wright State University
  • Michael J. Prayson, Wright State University
Document Type
Article
Publication Date
1-1-2017
Abstract

Background

Traditionally, operative fixation of pelvic and acetabular injuries involves complex approaches and significant complications. Accelerated rehabilitation, decreased soft tissue stripping and decreased wound complications are several benefits driving a recent interest in percutaneous fixation. We describe a new fluoroscopic view to guide the placement of screws within the anterior pelvic ring. Methods

Twenty retrograde anterior pelvic ring screws were percutaneously placed in ten cadaveric specimens. Arranging a standard C-arm in a position similar to obtaining a lateral hip image, with angles of 54° ± 2° beam to body, 75° ± 5° of reverse cantilever and 14° ± 6° of outlet, a gun barrel view of the anterior pelvic ring is identified. Fluoroscopic images were taken, and the hemipelvi were harvested to examine the dimensions of the anterior pelvic ring and inspected for any cortical or articular perforation. Results

The minimum cranial-to-caudal distance in the anterior pelvic ring was 9 mm (range 6.5–12 mm), and the minimum anterior-to-posterior dimension was 9 mm (range 5–15 mm). All but 2 screws were completely confined within the osseous corridors. Identifiable on final fluoroscopic evaluation, one screw perforated the psoas groove and a second perforated the acetabular dome. Overall, 90 % of our screws were accurately and safely placed, upon the first attempt, within the anterior pelvic ring using the described gun barrel view. Conclusion

Employing either open reduction, or following a closed or percutaneous reduction, the anterior pelvic ring gun barrel view can reproducibly guide safe placement of anterior pelvic ring screw fixation.

Citation Information
Nicholas Quercetti, Brandon R. Horne, Zachary J Dipaolo and Michael J. Prayson. "Gun Barrel View of the Anterior Pelvic Ring for Percutaneous Anterior Column or Superior Pubic Ramus Screw Placement" European Journal of Orthopaedic Surgery and Traumatology Vol. 27 (2017) p. 695 - 704 ISSN: 1633-8065
Available at: http://works.bepress.com/brandonr-horne/2/