Total Hip Acetabular Screw Placement - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Total Hip Acetabular Screw Placement - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the total hip arthroscopy acetabular screw placement. Utilizing acetabular screws in total hip arthroplasty is controversial. Screws can compress the cup and close any gap. Screws could be helpful in osteoporotic bone and when bone coverage is not sufficient. Screws and its holes can be conduit for migration of polyethylene debris that can cause osteolysis. (surgeon should insert the least number of screws). Many surgeons prefer to use screws in the acetabular cup. The quadrant technique is a safe technique of screw placement. It provides the surgeon with a simple, basic guide during surgery for safe placement of the screws during primary and revision surgery. How do you find the safe zone for placement of the acetabular screw? How do you find the danger zone so that you can avoid it? Draw a line from the ASIS to the center of the acetabulum. Draw a second line perpendicular to the first line. Four quadrants: 1- Posterosuperior 2- Anterosuperior 3- Anteroinferior 4- Posteroinferior Safe Zone is the posterior-superior with minimal risk to sciatic nerve, superior gluteal nerve and vessels. These structures are far away from this quadrant. direct the screws away from the notch. Danger zone can cause death (anterior-superior) external iliac artery and vein at risk. Danger zone (anterior-inferior) obturator nerve, artery and vein at risk. Caution zone (posterior-inferior) safe if screws are 20 mm. Risk include the sciatic nerve, inferior gluteal nevre and vessels, internal pudendal nerve and vessels. Retroverted vertical cup will be at most risk for injury to neurovascular structures. The structures can be at risk in a high hip center which is reamed superiorly ½ the native acetabular diameter. The new hip will have different anatomic zones than what the surgeon think. The antero-superior and the antero-inferior quadrants are positioned in the postero-superior quadrant (be aware of that shift in the zones). The insertion of the screws is guided by the quadrant method is based on a study done by Dr.Ray Waseiliwski. and his colleagues. When in doubt, aim the screws anteriorly to the greater sciatic notch. The bone will be stronger and thicker. Screws longer than 35 mm are usually not needed. Avoid drilling eccentrically because it may lift up the liner. The screw must be fully seated and the head of the screw should not be proud. If the screw is proud, the liner may not be seated properly. Vascular injury occurs more in females and more in the left hip. Become a friend on facebook:   / drebraheim   Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step