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Defining the iliac wing osseous fixation pathways: anatomy and implant constriction points

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner–outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor.

Methods

Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5 mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured.

Results

The IOTC is an elliptical area measuring 22.3 cm2. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5 mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3 mm in men and 13.8 mm in women (p < 0.001). The gluteal pillar diameter averaged 5.3 mm in men and 4.3 mm in women (p < 0.001).

Discussion

All ilia converge to a thin and frequently unicortical central region. A 4.5 mm iliac wing lag screw will not breach the cortex if it remains within 20 mm or 14 mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5 mm implants.

Conclusion

This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.

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Funding

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Orthopaedics & Rehabilitation, University of Vermont, 4th floor Safford Hall, 95 Carrigan Dr., Burlington, VT, 05405, USA

    Miqi Wang, Craig S. Bartlett & Patrick C. Schottel

  2. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave South, R200, Minneapolis, MN, 55454, USA

    Robert C. Jacobs

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  1. Miqi Wang
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Corresponding author

Correspondence to Miqi Wang.

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Conflict of interest

Craig S. Bartlett has received teaching honoraria from AO Trauma and DePuy-Synthes. He is also a paid consultant for SI Bone and Stryker Medical. Patrick C. Schottel is a paid consultant for Synthes. Miqi Wang and Robert C. Jacobs declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This study was reviewed by our institution’s IRB committee and found to be exempt from requiring ethics approval given the retrospective nature of the study and lack of Patient Health Information or identifiers utilized. As such, informed consent was not required.

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Wang, M., Jacobs, R.C., Bartlett, C.S. et al. Defining the iliac wing osseous fixation pathways: anatomy and implant constriction points. Arch Orthop Trauma Surg 142, 755–761 (2022). https://doi.org/10.1007/s00402-020-03681-3

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  • DOI: https://doi.org/10.1007/s00402-020-03681-3

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