Basic Sciences - Acetabular Screw Placement

Description

This video presentation covers the fundamentals of acetabular screw placement, essential for orthopedic surgeons. It begins with an introduction to the topic followed by a reference to a pivotal 1990 study published by Wasielewski et al. in the American JBJS, which investigated safe zones for screw placement during uncemented acetabular arthroplasty.



The discussion highlights the importance of avoiding damage to intrapelvic structures that are not visible during surgery. Using cadaveric studies, the researchers identified the locations of critical structures relative to fixed landmarks in the acetabulum, such as the anterior superior iliac spine and the ischial tuberosity.



The presentation outlines a method for defining safe zones, drawing lines through the acetabulum to create four quadrants. Each quadrant has associated risks:

- The anterior superior quadrant poses a high risk to the external iliac vein and artery.

- The anterior inferior quadrant can threaten the obturator nerve and vessels.

- The posterior inferior quadrant (PI) requires caution, particularly regarding the sciatic nerve, with screws shorter than 25 mm being safer.

- Finally, the posterior superior quadrant (PS) is identified as the safest area for screws shorter than 35 mm, significantly reducing risks to critical nerves and vessels.



Overall, the video emphasizes the anatomical considerations necessary for safe acetabular screw placement.

Specialties