How to obtain and identify the acetabular anterior column axial view projection in patients?

Abstract

Purpose: This study aims at sharing our experience as how to obtain and identify axial view image of the acetabular anterior column in patients. Methods: Pelvic computed tomography data of six normal adults were used to reconstruct three-dimensional (3D) models. The transparency of each 3Dmodel was downgraded at the view perpendicular to the cross section of the anterior columnaxis to simulate the anterior columnaxial viewimage. Fluoroscopywas performed in all patients to obtain the anterior column axial view image in the operating room. Each fluoroscopic image was compared with the corresponding simulation image to analyze potential anatomic landmarks that were helpful to identify the translucent area (projection of the screw path) in the patients. Results and Conclusions: To obtain ideal anterior column axial fluoroscopic image, the patient should be positioned supinewith the leg of '‘abnormal side’' straight and contralateral side flexion, abduction, and external rotation; theC-armmachine should be placed at the caudal endof theoperation tablewith theC-armfluoroscopic intensifier first positioned at the pelvic lateral view and then tilted approximately 30° toward the '‘abnormal side’' and rotated approximately 45° toward the caudal end of the operation table. To identify the translucent area on the anterior column axial viewfluoroscopic image obtained fromthe patient, the greater sciatic notch, the true pelvis edge, and the acetabulumshould be identified first and the translucent area is located in the area surrounded by these three anatomic landmarks.