Antegrade insertion of full-length ramus screws for the treatment of pelvic and/or acetabular fracture

Introduction

The success rate of antegrade insertion of a full-length ramus osseous fixation pathway (OFP) screw remains unreported. The objective of this study was to assess the safety, feasibility, and effectiveness of a novel antegrade technique for inserting full-length ramus screws, as well as to determine the parameters of the ramus OFP based on screw placement.

Patients and Methods

From January 2022 to September 2024, patients with fractures of the superior pubic ramus or the anterior acetabular column treated with a novel technique of an antegrade insertion of a superior ramus OFP screw were recruited into this study. Peri- and postoperative complications were documented. Parameters of the OFP were measured based on the position of the inserted full-length screws on postoperative CT scans.

Results

Thirty-eight fully threaded, large-diameter (7 mm) antegrade full-length screws were successfully inserted in 32 patients with no intraoperative screw insertion failures occurring. The procedure was performed without any noted wound infections or associated neurological, urological, and visceral complications. Postoperative CT images confirmed that all 38 ramus screws were correctly positioned within the bony corridors, with no evidence of screw breaching the hip joint. The OFP measures 118.9 ± 5.6 mm in length, with an angle projection of 38.7 ± 3.8 degrees to the horizontal plane and 15.8 ± 4.9 degrees to the coronal plane. All patients were followed for an average duration of 16.1 months (range, 6.2–31 months). Bone union was achieved in all cases with a union time of 3 months (range, 2.5 to 5 months), and no complications such as loss of reduction, screw loosening, breakage, or bone delayed union were noted.

Conclusions

Our novel antegrade technique for inserting a full-length large ramus screw has been validated for its safety, feasibility, and effectiveness. The parameters obtained through the insertion of a full-length screw in this study accurately represent those of our new ramus OFP and serve as a guide for the placement of full-length screws.