Publication: The mapping of danger zone for suprapectineal screw placement in quadrilateral plate osteosynthesis using 3D printed model
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Date
2022
Authors
Muthukkumar, Vinod Kumar
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Abstract
Introduction Open reduction and internal fixation (ORIF) are the gold standard treatment for acetabular injuries, despite risk of intra-articular screw placement where prevention is dependent on intra-operative use of image intensifier and three-dimensional (3D) imagination capacity of the surgeon. There is sparse documentation on safe zones for screw placement at the supra-pectineal region despite it being a common area encountered during osteosynthesis. This study aims to define the safe zones for screw placement at the supra-pectineal region and propose screw trajectories with the help of 3D printed model of the pelvis. Methodology This is a retrospective study using computed tomography (CT) pelvis images from patient’s records in Hospital Universiti Sains Malaysia (HUSM). The inclusion criteria include 18 to 60 years at the time of Computed Tomography (CT) scan regardless of gender. CT scans reported to have abnormalities, pathology or prior instrumentations were excluded from the study. Extracted CT images undergo multistep process of fragmentation and slicing to produce file format which can be 3D printed using the Creality CR-6 max FDM 3D printer. Measurements of the absolute and relative danger zones, as well as the minimal posterior inclination angle were measured. All analyses were conducted using IBM SPSS Statistics 26. The statistical analyses that were used in this study were descriptive statistics and an Independent t-test. Results A total of 30 CT scans were used in this study. The mean (SD) age of patients was 33.50(13.08) years old. A total of 20 scans (66.7%) belonged to male patients, and 10 scans (33.3%) belonged to female patients. Mean difference between gender was statistically significant for length AC (P<0.05) where male patients (Mean=4.89, SD=0.33) lengths were higher than female patients (Mean=4.40, SD=0.47). There were no significant mean differences in other parameters investigated. Conclusion Defining absolute and relative danger zones together with ascertaining safe juxta-articular screw trajectory had made this study a guide for surgeons endeavouring on pelvic or acetabular surgery with the aim of reducing incidence of intra-articular screw insertion, decreasing surgical time, and reducing dependence on image intensifier.
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Keywords
Acetabular fractures , quadrilateral plate