Article Text

Download PDFPDF
Relative position of the supra-acetabular bone to the crestal plane: a radiological analysis
  1. George Dehn1,
  2. N Hammer1,
  3. M C Wyatt1,
  4. S J Soltani2 and
  5. D C Kieser3,4
  1. 1Division of Health Sciences, University of Otago, Dunedin, New Zealand
  2. 2Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Orthopaedics, University of Otago, Dunedin, New Zealand
  4. 4Medical Corps, New Zealand Defence Force, Wellington, New Zealand
  1. Correspondence to Capt D C Kieser, Orthopaedics, University of Otago, Dunedin 9016, New Zealand; kieserdavid{at}gmail.com

Abstract

Introduction Displaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments and in extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel.

Methods A radiological review of 50 randomised pelvic CT scans in European patients aged 18–30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined.

Results The supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin’s entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side.

Conclusions The supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon’s thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.

  • pelvis
  • fracture
  • fixation
  • anatomy
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors DCK: study design, overview, literature review, data analysis, write-up. GD: data collection, analysis, write-up, review. SJS: data collection, analysis, write-up, review. MCW: data collection, literature review, analysis, manuscript review. NH: data collection, literature review, analysis, write-up.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was sought but deemed unnecessary as the images reviewed were de-identified and part of a data repository.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.