Is the both column fixation corridor a universally valid and consistent fixation pathway in pelvic and acetabular surgery?

Abstract

Introduction: The Both Column Fixation Corridor (BCFC) and Both Column Screws (BCS) represent innovative concepts in orthopedic surgery, yet they have not been extensively studied in the literature. This study aims to validate the BCFC as a consistent fixation pathway across genders, evaluate its axial fluoroscopic visualization, and investigate gender-specific anatomical variations for surgical planning.

Materials and methods: In this study, pelvic CT data from 400 adults (200 males, 200 females) were analyzed using Fujifilm-Synapse 3D software. In the initial step, axial fluoroscopic visualization of the corridor was simulated, and the optimal antegrade entry point (OAEP) was identified. Subsequently, virtual placement of anterior and posterior screws (aBCS, pBCS) was performed radiologically within the corridor. Measurements included screw thickness (R), length (L), distances to the spina iliaca anterior superior (SIAS-aBCS, SIAS-pBCS), and the caudo-cranial (CCT) and centro-lateral (CLT) fluoroscopic tilts required for axial visualization of the BCFC and its OAEP.

Results: Fluoroscopic axial visualization of the BCFC and identification of the OAEP were successfully achieved in all models, enabling the placement of both anterior and posterior screws across genders. Measurements revealed the following average values for female and male pelvises, respectively: aBCS thicknesses were 6.5 ± 0.8 mm and 7.9 ± 0.9 mm (p < 0.001); lengths were 131.6 ± 8.8 mm and 146.8 ± 9.9 mm (p < 0.001); pBCS thicknesses were 6.5 ± 0.8 mm and 7.5 ± 0.7 mm (p < 0.001); lengths were 132.6 ± 9.7 mm and 148.3 ± 9.6 mm (p < 0.001); caudo-cranial tilts were 42.8°± 5.4 and 39.5°± 5.2 (p < 0.001); and centro-lateral tilts were 43.1°± 4.3 and 40.0°± 5.3 (p < 0.001). SIAS-pBCS distances were 38.5 ± 6.9 mm and 40.7 ± 7.5 mm (p = 0.003), while SIAS-aBCS distances were 29.7 ± 6.9 mm and 30.2 ± 6.7 mm (p = 0.467). All parameters, except for the SIAS-aBCS distance, exhibited statistically significant gender-specific differences.

Conclusion: The Both Column Fixation Corridor is a universally valid and consistent osseous fixation pathway present in both genders. It is suitable for the placement of two screws in pelvic and acetabular surgery, with careful consideration of gender-specific anatomical differences to optimize its application.

Keywords: Acetabulum fractures; Both column fixation corridor; Both column screw; Percutaneous fixation.

Fig. 1

3D-reconstructed image of the pelvis (A); Axial orientation of the 3D pelvic model (B); anteroposterior (AP) view of the pelvis (C); and fluoroscopic axial view illustrating the Both Column Fixation Corridor and its optimal antegrade entry point. The anterior boundary of the fixation corridor is indicated by a yellow dotted line marking the acetabular articular margin, while the posterior boundary is indicated by an orange dotted line representing the posterior column, which lies just anterior to the greater sciatic notch (D)

Fig. 2

Demonstration of the caudocranial tilt (A) and centrolateral tilt (B) necessary to visualize the Both Column Fixation Corridor and its optimal antegrade entry point fluoroscopically in an axial view (C)

Fig. 3

Axial fluoroscopic visualization of the Both Column Fixation Corridor, placement of both anterior and posterior Both Column Screws within the BCFC from the optimal antegrade entry point in the axial orientation (A), axial orientation of the pelvis for fluoroscopic imaging and the axial view of the Both Column Fixation Corridor on a 3D-reconstructed pelvic model (B), fluoroscopic simulations in pelvic AP view (C), iliac oblique view (D), obturator oblique view (E), and axial, sagittal, and coronal CT sections (F)

Fig. 4

Measurement of the distances from both the anterior and posterior Both Column Screws to the spina iliaca anterior superior (SIAS). Display of the distances of both screws to the SIAS on a 3D pelvic image (A) and demonstration of the measurement method on a 2D lateral pelvic radiograph (B)

Fig. 5

Preoperative and postoperative images of a patient with a both-column fracture of the left acetabulum treated via an ilioinguinal approach. Three-dimensional pelvic reconstructions obtained from different angles demonstrating the both-column fracture of acetabulum (A–C). Preoperative AP radiograph (D), fluoroscopic iliac oblique view showing anterior and posterior screws (aBCS, pBCS) (E), axial fluoroscopic image of the Both Column Fixation Corridor confirming both screws within the corridor boundaries (F), and early postoperative CT slices verifying the screws remain within the corridor in all axial, sagittal, and coronal sections (G-I). Postoperative 13-month follow-up radiographs (J, K)

Fig. 6

A representative case demonstrating the percutaneous application of the Both Column Screw (BCS) Fixation technique. 3D pelvic reconstructions obtained from different angles showing the fracture morphology (A, B); preoperative anteroposterior pelvic radiograph (C); mini incisions made in the supine position for percutaneous placement of the anterior column screw and both-column screw (D); mini posterolateral incision used in the lateral decubitus position for fixation of the posterior wall fracture (E); postoperative anteroposterior pelvic radiograph at 16 months (F); and iliac oblique view showing the final position of the BCS (G)