'Reverse guide wire' technique for placement of anterior column/superior pubic ramus screw in pelvis and acetabular surgery

We present a novel technique for placement of an antegrade anterior column/superior pubic ramus screw. After identification of the entry point, the guide wire is inserted into the iliac bone to a depth of 2–3 mm using the obturator outlet and the inlet fluoroscopic views (Fig 1).1 It is then withdrawn and reversed so the blunt end functions as the leading end, and reinserted. It is subsequently advanced with light hammering (Fig 2). The risks of cortex penetration and injury of the surrounding structures are minimized since the blunt end can bounce to the cortical bone and is self-redirected into the canal