OPTIMAL TECHNIQUE OF SCREW PLACEMENT IN THE ISCHIAL TUBEROSITY FOR POSTERIOR ACETABULAR FRACTURES

Thirty dry adult bony specimens and eight embalmed cadavers were used to report on the morphological data of the ischial tuberosity and to d etermine the most optimal technique for ischial tuberosity screw place ment for open reduction and internal fixation of posterior acetabular fractures. The average width, height, and depth of the ischial tuberos ity were 27.0 mm, 32.2 mm, and 32.4 mm, respectively. The average angl es between the posterior and medial aspects and between the posterior and lateral aspects of the ischial tuberosities were 79.5 degrees, and 111.5 degrees, respectively. The risk to the internal pudendal neurov ascular bundle increases with either a more medially placed screw or a laterally placed screw that is angled medially. The tendinous origin of the hamstrings becomes quite substantial (7-10 mm thick) at a point 2 cm distal to the inferior acetabular margin. The exposure of the is chial tuberosity should therefore be restricted to this level. The ent ry point of the screws should be 5 mm or 10 mm medial to the lateral m argin of the ischial tuberosity, and the screws should be directed 35- 40 degrees, 45-50 degrees, and 50-55 degrees caudally at the level of the inferior acetabular margin and 1 cm and 2 cm below it, respectivel y, to obtain the most favorable bony purchase.