Reduction and fixation capabilities of different plate designs for pubic symphysis disruption: A biomechanical comparison

Pizanis, A.; Garcia, Patric; Santelmann, Maike; Culemann, Ulf; Pohlemann, Tim

doi:10.1016/j.injury.2012.09.023

Cited by 23 publications

(13 citation statements)

References 19 publications

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“…APC are further classified depending on the estimated extent of injury, ranging from mechanically stable APCI via horizontally unstable APCII to completely unstable APCIII disruptions. While, there is a wide consensus that APCII and III should be stabilized surgically, the extent of stabilization in all APC is still under discussion . As a commonly stated postulate, a pubic symphysis widening of more than 25 mm indicates instabilities of the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments (APCII), and therefore requires surgical intervention.…”

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confidence: 99%

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Böhme

Lingslebe

Steinke

et al. 2014

Journal Orthopaedic Research

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Surgical stabilization of the pelvis following type II anteroposterior compression pelvic injuries (APCII) is based on the assumption that the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments disrupt simultaneously. Recent data on the ligaments contradict this concept. We aimed at determining the mechanisms of ligament failure in APCII computationally. In an individual osteoligamentous computer model of the pelvis, ligament load, and strain were observed for the two-leg stance, APCII with 100-mm symphyseal widening and for two-leg stance with APCII-related ligament failure, and validated with body donors. The anterior sacroiliac and sacrotuberous ligaments had the greatest load with 80% and 17% of the total load, respectively. APCII causes partial failure of the anterior sacroiliac ligament and the pelvis to become horizontally instable. The other ligaments remained intact. The sacrospinous ligament was negligibly loaded but stabilized the pelvis vertically. The interosseous sacroiliac and sacrotuberous ligaments are likely responsible for reducing the symphysis and might serve as an indicator of vertical stability. The sacrospinous ligament appears to be of minor significance in APCII but plays an important role in vertical stabilization. Further research is necessary to determine the influence of alterations in ligament and bone material properties. Keywords: anterior compression pelvic injury; finite element computer study; pelvic biomechanics; sacroiliac joint ligaments; pubic symphysis widening Anteroposterior compression pelvic injuries (APC) or "open book" injuries of the pelvis are most commonly the result of high velocity trauma related to motorcycle or motor vehicle accidents or falls from great heights. 1The Young-Burgess classification system of pelvic injury was developed to predict patient morbidity and mortality and to identify potential needs of non-surgical or operative treatment.1,2 APC are further classified depending on the estimated extent of injury, ranging from mechanically stable APCI via horizontally unstable APCII to completely unstable APCIII disruptions. While, there is a wide consensus that APCII and III should be stabilized surgically, 3,4 the extent of stabilization in all APC is still under discussion.5-7 As a commonly stated postulate, a pubic symphysis widening of more than 25 mm indicates instabilities of the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments 2 (APCII), and therefore requires surgical intervention. However, this value appears to be arbitrary and there is increasing biomechanical 8,9 and clinical evidence 10 that especially the sacrospinous and the sacrotuberous ligaments might not necessarily be injured in APCII and also that sacroiliac joint screws might not provide additional pelvic stability following these cases.11 Moreover, the function of the sacrospinous and sacrotuberous ligaments as pelvic stabilizers is questioned by several authors.12-15 In a previously developed computer model of the pelvic belt, we could prove th...

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The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Böhme

Lingslebe

Steinke

et al. 2014

Journal Orthopaedic Research

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“…8 ). Although more stable results may be achieved using pre-bent 6-hole plates with options for dynamic compression and screw locking mechanisms, we chose a 4-hole symphyseal non-locking plate for our control group 56 . Finally, the unilateral load applied in our single leg stance model can result in vertical translation and compression of the pubic symphysis, but is unlikely to cause re-widening.…”

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confidence: 99%

Trans-obturator cable fixation of open book pelvic injuries

Jordan

Jäckle

Sebastian

et al. 2021

Sci Rep

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Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

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“…Ein Unterschied zwischen den Platten konnte nicht nachgewiesen werden. Weiterhin sind die Kompressionskräfte eine Plattenosteosynthese mit dynamischer Kompression vorteilhaft, da sie eine straffe Vernarbung im Bereich der Symphyse begünstigen [ 20 ]. Auch wenn die Symphysenplatte im Vergleich zum Fixateur eine höhere Stabilität durch die frakturnähere Fixation aufweist [ 21 , 22 ], so können individuelle Risikofaktoren (Infektion, Adipositas, Demenz, M. Parkinson etc.)…”

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