Technical TrickThe Retrograde-Antegrade-Retrograde Technique for Successful Placement of a Retrograde Superior Ramus ScrewWeatherby, David J. MD*; Chip Routt, Milton L. Jr MD†; Eastman, Jonathan G. MD*Author Information *Department of Orthopaedic Surgery, Davis Medical Center, University of California, Sacramento, CA; and †Department of Orthopaedic Surgery, Health Sciences Center at Houston, McGovern Medical School, University of Texas, Houston, TX. Reprints: Jonathan G. Eastman, MD, Department of Orthopaedic Surgery, Davis Medical Center, University of California, 4860 Y St, Suite 3800, Sacramento, CA 95817 (e-mail: [email protected]). The authors report no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com). Institutional Review Board (IRB) approval was obtained for this study. Journal of Orthopaedic Trauma: July 2017 - Volume 31 - Issue 7 - p e224-e229 doi: 10.1097/BOT.0000000000000849 Buy SDC Metrics Abstract Summary: Stabilization of pelvic ring injuries and certain acetabular fractures using percutaneous techniques is becoming increasingly more common. Intramedullary superior ramus screw fixation is beneficial in both injury types. While implants can be placed in an antegrade or retrograde direction, parasymphyseal ramus fractures benefit from retrograde implant insertion. In some patients, the parabolic osseous anatomy or obstructing soft tissues of the anterior pelvis or thigh can prevent appropriate hand and instrumentation positioning for appropriate retrograde ramus screw insertion through the entire osseous fixation pathway. Instead of abandoning medullary fixation, we propose a technique utilizing cannulated screws to successfully place retrograde screws in this distinct clinical scenario. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.