Ji Wan Kim; Jung Min Park; Jae Suk Chang

doi:10.12671/jkfs.2013.26.1.32

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Original Article
Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans: Ji Wan Kim, M.D., Ph.D., Jung Min Park, M.D., Jae Suk Chang, M.D., Ph.D.; Journal of the Korean Fracture Society 2013;26(1):32-36.
DOI: https://doi.org/10.12671/jkfs.2013.26.1.32
Published online: January 17, 2013

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

^*Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Jae Suk Chang, M.D., Ph.D. Department of Orthopaedic Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: 82-2-3010-3530, Fax: 82-2-488-7877, jschang@amc.seoul.kr

• Received: July 16, 2012 • Revised: August 27, 2012 • Accepted: October 2, 2012

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Abstract
REFERENCES

Abstract

Purpose
To acquire anatomical data for the normal pelvic bone structure using three-dimensional computed tomography (3D CT) and to propose the most appropriate angle and screw length for safe screw insertion during symphysis pubis plating.
Materials and Methods
We performed 3D CT analysis in 52 patients who required plating and selected a medial and lateral insertion point between the symphysis pubis and the pubic tubercle. Using a three-dimensional medical image analysis program, we evaluated the appropriate screw length, sagittal angle, and oblique angle at each point in this cohort.
Results
At the medial point, the sagittal angle was determined to be 49.1° with an average screw length of 49.4 mm. At the lateral point, we calculated an average screw length of 49.1 mm, oblique angle of 23.2°, and sagittal angle of 45.7°. The screw length was longer in men than in women (4.6 mm and 7.3 mm, respectively) at the medial and lateral point.
Conclusion
At the symphysis pubis diastasis, we can insert the screw caudally at 49° with a minimal length of 37 mm at the medial point. We can insert the screw caudally at 46°, medially at 23°, with a minimal 34 mm length at the lateral point.
Key words: Pelvis, Pelvic ring injury, Pubic symphysis diastasis, Screw fixation

REFERENCES

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4. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res, 1989;(242):83-97.
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7. Ponson KJ, Hoek van Dijke GA, Joosse P, Snijders CJ, Agnew SG. Improvement of external fixator performance in type C pelvic ring injuries by plating of the pubic symphysis: an experimental study on 12 external fixators. J Trauma, 2002;53:907-912.
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Fig. 1

(A) Initial pelvis antero-posterior image of a 47-year-old male showing pelvic ring injury with sacroiliac joint fracture and dislocation and symphysis pubis diastasis.

(B) Postoperative radiograph demonstrating the protruded screw at left pubis.

Fig. 2

A schematic picture showing screw fixation of symphysis pubis. A mark (^*) of indicates pubic tubercle. Medial insertion point is the bisecting point between pubic tubercle and symphysis pubis; and lateral insertion point is just lateral to pubic tubercle.

Fig. 3

With 3-dimensional reconstruction image, measuring sagittal angle length at the medial insertion.

Fig. 4

With 3-dimensional reconstruction image, measuring.

(A) Sagittal angle and length.

(B) Oblique angle at the lateral position.

Table 1

The Measured Data at Medial and Lateral Point for Screw Insertion

Min: Minimum, Max: Maximum, Ave: Average.

Table 2

Distribution of Parameter

Figure & Data

REFERENCES

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Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans

J Korean Fract Soc. 2013;26(1):32-36. Published online January 31, 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.1.32

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Figure

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Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans

Fig. 1 (A) Initial pelvis antero-posterior image of a 47-year-old male showing pelvic ring injury with sacroiliac joint fracture and dislocation and symphysis pubis diastasis. (B) Postoperative radiograph demonstrating the protruded screw at left pubis.

Fig. 2 A schematic picture showing screw fixation of symphysis pubis. A mark (*) of indicates pubic tubercle. Medial insertion point is the bisecting point between pubic tubercle and symphysis pubis; and lateral insertion point is just lateral to pubic tubercle.

Fig. 3 With 3-dimensional reconstruction image, measuring sagittal angle length at the medial insertion.

Fig. 4 With 3-dimensional reconstruction image, measuring. (A) Sagittal angle and length. (B) Oblique angle at the lateral position.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans

Table 1

The Measured Data at Medial and Lateral Point for Screw Insertion

Min: Minimum, Max: Maximum, Ave: Average.

Table 2

Distribution of Parameter

Table 1 The Measured Data at Medial and Lateral Point for Screw Insertion

Min: Minimum, Max: Maximum, Ave: Average.

Table 2 Distribution of Parameter