{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T15:41:09Z","timestamp":1793029269245,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Minimally invasive surgeries for acetabulum fracture fixation are gaining popularity due to their known advantages versus open reduction and internal fixation. Antegrade or retrograde screw fixation along the long axis of the posterior column of the acetabulum is increasingly applied in surgical practice. While there is sufficient justification in the literature for the application of the anterior approach, there is a deficit of reports related to the posterior approach. The aim of this study was to evaluate the biomechanical competence of posterior column acetabulum fracture fixation through antegrade screw placement using either a standard cannulated screw or a cannulated compression headless screw (CCHS) via posterior approach. Materials and Methods: Eight composite pelvises were used, and a posterior column acetabulum fracture according to the Letournel Classification was simulated on both their left and right sides via an osteotomy. The sixteen hemi-pelvic specimens were assigned to two groups (n = 8) for either posterior column standard screw (group PCSS) or posterior column CCHS (group PCCH) fixation. Biomechanical testing was performed by applying steadily increased cyclic load until failure. Interfragmentary movements were investigated by means of motion tracking. Results: Initial stiffness demonstrated significantly higher values in PCCH (163.1 \u00b1 14.9 N\/mm) versus PCSS (133.1 \u00b1 27.5 N\/mm), p = 0.024. Similarly, cycles and load at failure were significantly higher in PCCH (7176.7 \u00b1 2057.0 and 917.7 \u00b1 205.7 N) versus PCSS (3661.8 \u00b1 1664.5 and 566.2 \u00b1 166.5 N), p = 0.002. Conclusion: From a biomechanical perspective, CCHS fixation demonstrates superior stability and could be a valuable alternative option to the standard cannulated screw fixation of posterior column acetabulum fractures, thus increasing the confidence in postoperative full weight bearing for both the patient and treating surgeon. Whether uneventful immediate postoperative full weight bearing can be achieved with CCHS fixation should primarily be investigated in further human cadaveric studies with a larger sample size.<\/jats:p>","DOI":"10.3390\/medicina59071214","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:41:45Z","timestamp":1687999305000},"page":"1214","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Antegrade Posterior Column Acetabulum Fracture Screw Fixation via Posterior Approach: A Biomechanical Comparative Study"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9582-1810","authenticated-orcid":false,"given":"Till","family":"Berk","sequence":"first","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0484-887X","authenticated-orcid":false,"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8747-6786","authenticated-orcid":false,"given":"Peter","family":"Schwarzenberg","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3543-0636","authenticated-orcid":false,"given":"Ludmil","family":"Drenchev","sequence":"additional","affiliation":[{"name":"Institute of Metal Science \u2018\u2018Acad. A. Balevski\u2019\u2019, Bulgarian Academy of Sciences, 1574 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hristo Kostov","family":"Skulev","sequence":"additional","affiliation":[{"name":"Institute of Metal Science \u2018\u2018Acad. A. Balevski\u2019\u2019, Bulgarian Academy of Sciences, 1574 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Pfeifer","sequence":"additional","affiliation":[{"name":"Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Pastor","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-2480","authenticated-orcid":false,"given":"Geoff","family":"Richards","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Christoph","family":"Pape","sequence":"additional","affiliation":[{"name":"Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/1471-2474-15-303","article-title":"Fluoroscopic views for safe insertion of lag screws into the posterior column of the acetabulum","volume":"15","author":"Chen","year":"2014","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1186\/s13018-022-03347-3","article-title":"The placement of percutaneous retrograde acetabular posterior column screw based on imaging anatomical study of acetabular posterior column corridor","volume":"17","author":"Yu","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.injury.2017.01.028","article-title":"Computational analysis of the safe zone for the antegrade lag screw in posterior column fixation with the anterior approach in acetabular fracture: A cadaveric study","volume":"48","author":"Jung","year":"2017","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.injury.2016.01.026","article-title":"Definition of a safe zone for antegrade lag screw fixation of fracture of posterior column of the acetabulum by 3D technology","volume":"47","author":"Feng","year":"2016","journal-title":"Injury"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s002640000138","article-title":"Screw fixation of acetabular fractures","volume":"24","author":"Hoffmann","year":"2000","journal-title":"Int. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00005131-199801000-00009","article-title":"Percutaneous fixation of the columns of the acetabulum: A new technique","volume":"12","author":"Starr","year":"1998","journal-title":"J. Orthop. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s00402-010-1095-2","article-title":"Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation","volume":"130","author":"Hong","year":"2010","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1007\/s00402-009-0836-6","article-title":"Quantitative anatomic basis of antegrade lag screw placement in posterior column of acetabulum","volume":"129","author":"Mu","year":"2009","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/230949900301100206","article-title":"Quantitative anatomic characterisation of the pelvic brim to facilitate internal fixation through an anterior approach","volume":"11","author":"Shiramizu","year":"2003","journal-title":"J. Orthop. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0020-1383(01)00060-2","article-title":"Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the acetabulum","volume":"32","author":"Starr","year":"2001","journal-title":"Inj. Int. J. Care Inj."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/BOT.0b013e318299c8fb","article-title":"Percutaneous retrograde posterior column acetabular fixation: Is the sciatic nerve safe? A cadaveric study","volume":"28","author":"Azzam","year":"2014","journal-title":"J. Orthop. Trauma"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.injury.2004.09.016","article-title":"Percutaneous retrograde screwing for stabilisation of acetabular fractures","volume":"36","author":"Mouhsine","year":"2005","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.injury.2010.07.502","article-title":"Computer-assisted periacetabular screw placement: Comparison of different fluoroscopy-based navigation procedures with conventional technique","volume":"41","author":"Ochs","year":"2010","journal-title":"Injury"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1055\/s-2007-980136","article-title":"Acetabulum fractures: Classification and management","volume":"5","author":"Letournel","year":"2007","journal-title":"Orthop. Trauma Dir."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3185","DOI":"10.1007\/s00068-021-01872-0","article-title":"Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating","volume":"48","author":"Wenzel","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1002\/jor.23825","article-title":"Standardization of hemipelvis alignment for in vitro biomechanical testing","volume":"36","author":"Morosato","year":"2018","journal-title":"J. Orthop. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/S0021-9290(01)00040-9","article-title":"Hip contact forces and gait patterns from routine activities","volume":"34","author":"Bergmann","year":"2001","journal-title":"J. Biomech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/BOT.0b013e3182163345","article-title":"Angular stability potentially permits fewer locking screws compared with conventional locking in intramedullary nailed distal tibia fractures: A biomechanical study","volume":"25","author":"Gueorguiev","year":"2011","journal-title":"J. Orthop. Trauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.clinbiomech.2008.09.005","article-title":"Quantification of cancellous bone-compaction due to DHS\u00ae Blade insertion and influence upon cut-out resistance","volume":"24","author":"Windolf","year":"2009","journal-title":"Clin. Biomech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2340\/16501977-2532","article-title":"A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities","volume":"51","author":"Meys","year":"2019","journal-title":"J. Rehabil. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1016\/j.jbiomech.2005.06.026","article-title":"Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living","volume":"39","author":"Yoshida","year":"2006","journal-title":"J. Biomech."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1586\/erd.10.53","article-title":"The use of titanium and stainless steel in fracture fixation","volume":"7","author":"Hayes","year":"2010","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.injury.2004.05.024","article-title":"Screw fixation of the syndesmosis: A cadaver model comparing stainless steel and titanium screws and three and four cortical fixation","volume":"36","author":"Beumer","year":"2005","journal-title":"Injury"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s005860050218","article-title":"Titanium-alloy enhances bone-pedicle screw fixation: Mechanical and histomorphometrical results of titanium-alloy versus stainless steel","volume":"9","author":"Christensen","year":"2000","journal-title":"Eur. Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1302\/0301-620X.87B11.16614","article-title":"The use of a virtual three-dimensional model to evaluate the intraosseous space available for percutaneous screw fixation of acetabular fractures","volume":"87B","author":"Attias","year":"2005","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/00003086-200111000-00057","article-title":"Comparative strength of three methods of fixation of transverse acetabular fractures","volume":"392","author":"Chang","year":"2001","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1136\/bjsports-2016-096677","article-title":"AO Surgery Reference: A comprehensive guide for management of fractures","volume":"51","author":"Nambiar","year":"2017","journal-title":"Br. J. Sport. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s10439-009-9887-7","article-title":"Mechanical evaluation of large-size fourth-generation composite femur and tibia models","volume":"38","author":"Gardner","year":"2010","journal-title":"Ann. Biomed. Eng."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3282","DOI":"10.1016\/j.jbiomech.2008.08.013","article-title":"Structural properties of fourth-generation composite femurs and tibias","volume":"41","author":"Heiner","year":"2008","journal-title":"J. Biomech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1243\/09544119JEIM409","article-title":"Cancellous bone screw purchase: A comparison of synthetic femurs, human femurs, and finite element analysis","volume":"222","author":"Zdero","year":"2008","journal-title":"Proc. Inst. Mech. Eng. Part H J. Eng. Med."},{"key":"ref_31","first-page":"111","article-title":"Composite bone models in orthopaedic surgery research and education","volume":"22","author":"Elfar","year":"2014","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s00264-015-3007-0","article-title":"Analysis of sacro-iliac joint screw fixation: Does quality of reduction and screw orientation influence joint stability? A biomechanical study","volume":"40","author":"Zderic","year":"2016","journal-title":"Int. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/BOT.0b013e318126bb8e","article-title":"Sacroiliac joint compression using an anterior pelvic compressor: A mechanical study in synthetic bone","volume":"21","author":"Gardner","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/00005131-200308000-00002","article-title":"Biomechanical comparison of posterior pelvic ring fixation","volume":"17","author":"Yinger","year":"2003","journal-title":"J. Orthop. Trauma"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"411","DOI":"10.3944\/AOTT.2013.2840","article-title":"Internal fixation of bilateral sacroiliac dislocation with transiliac locked plate: A biomechanical study on pelvic models","volume":"47","author":"Sahin","year":"2013","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/00005131-200403000-00002","article-title":"Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating","volume":"18","author":"Sagi","year":"2004","journal-title":"J. Orthop. Trauma"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1214\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:02:45Z","timestamp":1760126565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1214"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,28]]},"references-count":36,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["medicina59071214"],"URL":"https:\/\/doi.org\/10.3390\/medicina59071214","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,28]]}}}