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Percutaneous screws insertion sites

Intramedullary pubic ramus screws can be placed retrograde or antegrade through percutaneous stab wounds.

Retrograde screws, from the pubis laterally, are inserted through an incision made over the contralateral pubic tubercle. C-arm fluoroscopy is essential to define the starting point and passage of drill bit and screw within the superior pubic ramus, across the fracture, and cephalad to the acetabulum. The inlet and obturator outlet views are essential for confirming proper screw placement.