Danger Zone of the Acetabulum

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Abstract
Summary The danger zone of the acetabulum is defined by Marvin Tile as that part of the posterior wall and column at the mid-acetabulum lying above the ischial spine. Screws inserted in the danger zone are at risk of violating the hip joint. Unfortunately, this zone is frequently used in the fixation of posterior wall and column fractures. Cadaveric studies were performed analyzing 1-cm cross-sections through the acetabulum for the purpose of studying the anatomical configuration of the danger zone. The plane of the cross-section was perpendicular to the posterior column. Each cross-section had the medial boundary of the acetabulum projected onto the posterior column. The cross-sections were then assembled to form the original acetabulum. By analyzing the projections on the posterior column, the exact configuration of the danger zone was determined. Screws placed at the margin of the danger zone and directed perpendicular to the posterior column violated the hip joint. Through analysis of the cross-sections, safe anatomic pathways were developed for screw placement. Cortical screws (4.5 mm), placed at entry points of 2 cm and 3 cm medial to the lateral acetabular margin and angled medially 45 and 15, respectively, did not violate the hip joint. The angulation was respective to the perpendicular to the posterior column. In this study, the average width of the posterior column at the mid-acetabular level was 4.8 cm. Computed tomography scan of the acetabulum yielded valuable information regarding screw placement in the posterior column. Software analysis of the inclination of the acetabulum, with respect to the perpendicular to the posterior column, provided safe anatomic pathways for screw placement. This method of analysis could prove valuable in preoperative planning for internal fixation of posterior wall fractures.

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