An exploratory study of pelvis anatomy to revise the bony canal used for LC2 screw insertion

BACKGROUND: Percutaneous screw placement, especially the insertion of LC2 screws, is technically demanding. Although the traditional LC2 bony canal spans the anterior inferior iliac spine (AIIS) to the posterior superior iliac spines (PSIS), a high perforation rate has been reported. OBJECTION: The aim of this research was to design a revised bony canal, measure the canal width and length and guide the insertion of LC2 screws for pelvic fractures. MATERIALS AND METHODS: The plane tool in the Mimics analysis menu was used to draw a midplane connecting the midpoint between the anterior inferior spine and the PSIS upper flat region with pelvic CT data. The minimum widths of the upper, middle, lower surfaces of the tunnel and perforation rate were measured and compared. The ideal screw length was also measured along the longitudinal axis running through the midpoint of the midplane. RESULTS: The minimum widths of the upper, middle and lower surfaces of the revised canal were 3.63 mm, 7.7 mm, and 11.93 mm, respectively, in males and 5.97 mm, 9.93 mm, and 12.45 mm, respectively, in females. Significant differences were observed among the upper, middle and lower surfaces of the revised canal in male patients (P < 0.001). In female subjects, the upper canal surface was significantly different from the middle and lower canal surfaces (P < 0.001). The perforation rate was significantly decreased especially in females pelvic. The channel length passing through the midpoint of the narrowest position of the pelvis was 130.85 ± 8.02 mm in males and 124.30 ± 7.71 mm in females and was significantly different for male and female pelvises (P = 0.004). CONCLUSION: The LC2 screw should be inserted along the intersection line of the AIIS lateral wall and the iliac body. The screw should be inserted under the line between the midpoint of the AIIS and the PSIS upper flat region to ensure accuracy of placement. LC2 screws can be more easily inserted in males than in females, and the rate of cortical perforation can be significantly decreased under the guidance of the newly proposed canal.