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Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty

The Journal of Bone & Joint Surgery.  1990; 72:501-508 
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Abstract

An anatomical and radiographic study was undertaken to determine the safest zones in the acetabulum for the transacetabular placement of screws during uncemented acetabular arthroplasty. To avoid injury to intrapelvic structures, which are not visible to the surgeon during placement of the screws, cadavera were studied to define the location of these structures with respect to fixed points of reference within the acetabulum. Four clinically useful acetabular quadrants were delineated. The quadrants are formed by drawing a line from the anterior superior iliac spine through the center of the acetabulum to the posterior fovea, forming acetabular halves. A second line is then drawn perpendicular to the first at the mid-point of the acetabulum, forming four quadrants. The posterior superior and posterior inferior acetabular quadrants contain the best available bone stock and are relatively safe for the transacetabular placement of screws. The anterior superior and anterior inferior quandrants should be avoided whenever possible, because screws placed improperly in these quadrants may endanger the external iliac artery and vein, as well as the obturator nerve, artery, and vein. The acetabular-quadrant system provides the surgeon with a simple intraoperative guide to the safe transacetabular placement of screws during primary and revision acetabular arthroplasty.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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