Abstract
Abstract
Background/Purpose
The surgical fixation of a symphyseal diastasis in partially or fully unstable pelvic ring injuries is an important element when stabilizing the anterior pelvic ring. Currently, open reduction and internal fixation (ORIF) by means of plating represents the gold standard treatment. Advances in percutaneous fixation techniques have shown improvements in blood loss, surgery time, and scar length. Therefore, this approach should also be adopted for treatment of symphyseal injuries. The technique could be important since failure rates, following ORIF at the symphysis, remain unacceptably high. The aim of this biomechanical study was to assess a semi-rigid fixation technique for treatment of such anterior pelvic ring injuries versus current gold standards of plate osteosynthesis.
Methods
An anterior pelvic ring injury type III APC according to the Young and Burgess classification was simulated in eighteen composite pelvises, assigned to three groups (n = 6) for fixation with either a single plate, two orthogonally positioned plates, or the semi-rigid technique using an endobutton suture implant. Biomechanical testing was performed in a simulated upright standing position under progressively increasing cyclic loading at 2 Hz until failure or over 150,000 cycles. Relative movements between the bone segments were captured by motion tracking.
Results
Initial quasi-static and dynamic stiffness, as well as dynamic stiffness after 100,000 cycles, was not significantly different among the fixation techniques (p ≥ 0.054).). The outcome measures for total displacement after 20,000, 40,000, 60,000, 80,000, and 100,000 cycles were associated with significantly higher values for the suture technique versus double plating (p = 0.025), without further significant differences among the techniques (p ≥ 0.349). Number of cycles to failure and load at failure were highest for double plating (150,000 ± 0/100.0 ± 0.0 N), followed by single plating (132,282 ± 20,465/91.1 ± 10.2 N), and the suture technique (116,088 ± 12,169/83.0 ± 6.1 N), with significantly lower values in the latter compared to the former (p = 0.002) and no further significant differences among the techniques (p ≥ 0.329).
Conclusion
From a biomechanical perspective, the semi-rigid technique for fixation of unstable pubic symphysis injuries demonstrated promising results with moderate to inferior behaviour compared to standard plating techniques regarding stiffness, cycles to failure and load at failure. This knowledge could lay the foundation for realization of further studies with larger sample sizes, focusing on the stabilization of the anterior pelvic ring.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine,Orthopedics and Sports Medicine,Emergency Medicine,Surgery
Reference48 articles.
1. Avilucea FR, Whiting PS, Mir H. Posterior fixation of APC-2 pelvic ring injuries decreases rates of anterior plate failure and malunion. JBJS. 2016;98:944–51.
2. Zhou SR. Fracture-dislocation of pelvis in the adult female: clinical analysis of 105 cases. Zhonghua wai ke za zhi [Chin J Surg]. 1989;27:479–81.
3. Kellam J, Mayo K (2003) Pelvic ring disruption. Pelvic fractures. Skeletal Trauma 3rd Ed Philadelphia, PA: WB Saunders 1063
4. Tile M, Helfet DL, Kellam JF, Vrahas M (1995) Fractures of the pelvis and acetabulum. Williams & Wilkins Baltimore.
5. Stocks GW, Gabel GT, Noble PC, Hanson GW, Tullos HS. Anterior and posterior internal fixation of vertical shear fractures of the pelvis. J Orthop Res. 1991;9:237–45.