Anterior column screw
Further fixation of the anterior column to the distal part of the pubis can also be achieved through lag screws that run from the medius gluteal pillar to the pubis (depending on fracture configuration and necessity).
One or two 3.5 mm lag screws are used to stabilize the inferior part of the anterior column fracture.
The starting point for the anterior column screw applied through the extended iliofemoral exposure is different than that applied through the Kocher-Langenbeck. The starting point begins 3-4 cm above the lateral rim of the acetabulum, just posterior to the gluteus medius pillar.
The trajectory follows the axis of the anterior column which is easily seen along the pectineal eminence through this exposure. For the correct direction, use the index finger along the pubic ramus and try to target it with the drill bit.
The correct inclination and direction of the screw must be confirmed with fluoroscopic imaging (modified Judet views).
Take great care not to penetrate the hip joint.
Use an oscillating drill and progress slowly. Remember that the external iliac vessels lie immediately adjacent to the superior pubic ramus.