Osteology of the ilium revised: illuminating the clinical relevance
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ORIGINAL ARTICLE
Osteology of the ilium revised: illuminating the clinical relevance Alexander von Glinski1,2,3,4 · Sven Frieler1,2,3,4 · Emre Yilmaz3 · Basem Ishak1,2 · Ryan Goodmanson1,2 · Joe Iwanaga2 · Thomas A. Schildhauer3 · Jens R. Chapman1 · Rod J. Oskouian1,2 · Keith Mayo4 · R. Shane Tubbs1,5 Received: 18 May 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Several studies on anterior and posterior pelvic ring fixation have identified a fragile monocortical area located at the iliac wing. However, there are no current studies regarding this structure’s dimensions and relation to known anatomic structures. Methods Eleven human ilia were dissected from 6 specimens. After debulking soft tissue, photoluminescence was used to indicate the fragile area. The size and thickness of the iliac wing were determined and mapped in relation to the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Results This photoluminescent unicortical area measured 15.57 cm2 with a mean minimal thickness of 1.37 mm at its thin‑ nest part. Its average diameter was 41.15 mm horizontally and 37.45 mm vertically. In all cases, it was located at the middle third of the ilium with a mean distance of 64.58 mm to the AIIS and 62.73 mm to the PSIS. Trajectory angulation above 4.5° from the PSIS lead to violation of this area. Conclusion This study provides useful anatomical information regarding a thin unicortical area at the iliac wing that is rel‑ evant to anterior and posterior pelvic ring fixation and the potential complications that can arise from iatrogenic perforation of this area. Keywords Ilium osteology · Pelvic anatomy · Sacropelvic fixation · Tricortical iliac graft
Introduction The iliac wing’s thickness (transverse thickness between the inner and outer cortex) is one of the most critical determi‑ nants in anterior and posterior pelvic ring fixation and bone marrow harvesting via trocar aspiration [1–3]. Judet was the first to document the ilium’s important anatomic features related to surgery [4]. Further anatomical and radiological * Sven Frieler [email protected] 1
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
2
Seattle Science Foundation, Seattle, WA, USA
3
Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle‑de‑la‑Camp‑Platz 1, 44789 Bochum, Germany
4
Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA
5
Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada
studies have investigated the human ilium and it’s corre‑ lation to different anatomical landmarks without quantita‑ tive analysis [5, 6]. Several clinical studies have identified a delicate part of the iliac wing that might cause problems in harvesting the iliac crest [7] or that potentially could cause hardware perforation in anterior or posterior pelvic ring fixa‑ tion because of its thinness [2, 8]. Moreover, t
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