• OBJECTIVE
    • Safe posterior column screw fixation via an anterior approach under two-dimensional fluoroscopic control.
  • INDICATIONS
    • Anterior column with posterior hemitransverse fractures (ACPHF); transverse fractures; two-column fractures and T‑type fractures without relevant residual displacement of the posterior column after reduction of the anterior column and the quadrilateral plate.
  • CONTRAINDICATION
    • Acetabular fractures requiring direct open reduction via a posterior approach; very narrow osseous corridor in preoperative planning; insufficient intraoperative fluoroscopic visualization of the anatomical landmarks.
  • SURGICAL TECHNIQUE
    • Preoperative planning of the starting point and screw trajectory using a standard pelvic CT scan and a multiplanar reconstruction tool. Intraoperative fluoroscopically controlled identification of the starting point using the anterior-posterior (ap) view. Advancing the guidewire under fluoroscopic control using the lateral-oblique view. Lag screw fixation of the posterior column with cannulated screws.
  • POSTOPERATIVE MANAGEMENT
    • Partial weight bearing as advised by the surgeon. Postoperative CT scan for the assessment of screw position and quality of reduction of the posterior column. Generally no implant removal.
  • RESULTS
    • In a series of 100 pelvic CT scans, the mean posterior angle of the ideal posterior column screw trajectory was 28.0° (range 11.1-46.2°) to the coronal plane and the mean medial angle was 21.6° (range 8.0-35.0°) to the sagittal plane. The maximum screw length was 106.3 mm (range 82.1-135.0 mm). Twelve patients were included in this study: 10 ACPHF and 2 transverse fractures. The residual maximum displacement of the posterior column fracture component in the postoperative CT scan was 1.4 mm (0-4 mm). There was one intraarticular screw penetration and one perforation of the cortical bone in the transition zone between the posterior column and the sciatic tuber without neurological impairment.