Acetabular reconstruction: from fracture pattern to fixation-part 2.

Abstract

Percutaneous screw fixation has become an essential component of acetabular fracture management. However, most literature treats individual screws as technical elements rather than components of a coherent biomechanical system. This study proposes a function-based framework for periacetabular screw selection, aiming to align screw type with fracture morphology, anatomical corridors, imaging requirements, and mechanical objectives. This narrative review synthesizes anatomical, biomechanical, and fluoroscopic principles from existing literature and clinical experience. Key periacetabular screws were categorized by their function, osseous pathway, imaging views, and relevance to specific fracture patterns. Technical tips and avoidance strategies were outlined for each screw type. Six principal screw types: anterior column, posterior column, LC-2, infra-acetabular, and the so-called "magic" screw, were described across five fracture families. Each screw's trajectory, starting point, radiographic control, and anatomical considerations were detailed. The framework connects fracture pattern with implant function to facilitate surgical planning and decision-making. This screw-focused model provides a comprehensive and practical framework to guide implant selection in acetabular fracture fixation. By integrating anatomy, radiographic control, and fracture mechanics, this system supports standardized, reproducible, and safe surgical strategies for managing complex acetabular injuries.