A biomechanical cadaver comparison of suture button fixation to plate fixation for pubic symphysis diastasis

Kiskaddon, Eric M.; Wright, Amanda; Meeks, Brett D.; Froehle, Andrew W.; Gould, Greg; Lubitz, Marc G.; Prayson, Michael J.; Horne, Brandon R.

doi:10.1016/j.injury.2018.09.032

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…Supporting our evidence, Kiskaddon et al likewise reported a sufficient biomechanical stability of a nitinol wire construct (TightRope ® , Arthrex, Naples, FL) when compared to a symphyseal plate [29]. However, these authors used an endobutton technique for the fixation of the TightRopes ® on the posterior symphyseal surface [29]. This technique requires the surgical access to the posterior side of the symphyseal joint, potentially irritating or even endangering the urinary bladder and the surrounding tissue when implanting the endobuttons [29].…”

Section: Discussionsupporting

confidence: 85%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Kußmaul

Schwaabe

Kistler³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge™) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. Materials and methods Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge™ in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. Results Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge™ techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). Conclusions Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge™ as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior.

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Section: Discussionsupporting

confidence: 85%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Kußmaul

Schwaabe

Kistler³

et al. 2021

Arch Orthop Trauma Surg

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“…For the management of partially unstable pelvic ring injuries, even suture button fixation of the pubic symphysis has been found to be biomechanically similar to plate fixation in terms of the achieved stability 15 . There is no clear consensus on whether fixation of the pubic symphysis should always be performed to augment spinopelvic fixation in this situation regardless of the method of fixation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis

Kanbara

Nohara

Ohara

et al. 2020

Spine Surg Relat Res

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Introduction: In patients with lumbosacral agenesis (SA), Renshaw type III or IV, lumbosacral instability is the primary cause of major clinical complications. Although they are usually treated with spinopelvic fusion, nonunion at the spinopelvic junction is a major complication due to the congenital sacropelvic abnormalities. The purpose of this study was to evaluate whether a combination of lumbosacral fixation and rigid fixation at the pubic symphysis could lead to postoperative bone union in patients with SA (Renshaw type III).Methods: Retrospective case series study. We present the cases of two patients with SA, Renshaw type III, who were surgically treated by lumbosacral fusion using a posterior approach, and they exhibited nonunion at the lumbosacral junction.Results: Case 1. A 10-year-old male underwent T8-S posterior fixation followed by multiple augmentations using allografts at the lumbosacral junction for delayed union. All additional procedures with bone graft using a posterior approach failed to achieve bone union; however, additional rigid fixation at the pubic symphysis resulted in a successful lumbosacral bone union. Case 2. A 6-year-old male underwent vertical expandable prosthetic titanium rib (VEPTR) surgery with multiple rod extension procedures. Subsequently, at the age of 10 years, a combined two-stage anterior (L1-3) and posterior (T8-iliac) fixation with T9 hemivertebrectomy was performed. As a result of subsequent nonunion with screw loosening, additional rigid fixation at the pubic symphysis was performed 1 month after posterior fixation. Bone union was finally achieved 1 year after all the surgical interventions. Conclusion: Rigid fixation at the pubic symphysis may play a significant role in achieving rigid bone union for unstable lumbopelvic connection, such as SA, Renshaw type III or IV.

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“…Disruption of the pubic symphysis exceeding 25 mm is believed to be an absolute indication for operative intervention [ 5 ]. Several fixation strategies are used to enhance the stability of the anterior pelvic ring, such as external, internal, percutaneous, and subcutaneous fixation devices [ 6 , 11 – 17 ]. Internal fixation of the anterior plate combined with posterior percutaneous cannulated screws is the preferred method to treat PSD, considering that 54–97% of anterior pelvic ring fractures are associated with posterior pelvic ring injuries [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of seven fixation methods to treat pubic symphysis diastasis using finite element analysis

et al. 2022

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Background Pubic symphysis diastasis (PSD) hinders the connection between bilateral ischia and pubic bones, resulting in instability of the anterior pelvic ring. PSD exceeding 25 mm is considered disruptions of the symphyseal and unilateral/bilateral anterior sacroiliac ligaments and require surgical intervention. The correct choice of fixation devices is of great significance to treat PSD. This study aimed to evaluate the construct stability and implant performance of seven fixation methods to treat PSD using finite element analysis. Methods The intact skeleton-ligament pelvic models were set as the control group. PSD models were simulated by removing relevant ligaments. To enhance the stability of the posterior pelvic ring, a cannulated screw was applied in the PSD models. Next, seven anterior fixation devices were installed on the PSD models according to standard surgical procedures, including single plates (single-Plate group), single plates with trans-symphyseal cross-screws (single-crsPlate group), dual plates (dual-Plate group), single cannulated screws, dual crossed cannulated screws (dual-canScrew group), subcutaneous plates (sub-Plate group), and subcutaneous pedicle screw-rod devices (sub-PedRod group). Compression and torsion were applied to all models. The construct stiffness, symphyseal relative micromotions, and von Mises stress performance were recorded and analyzed. Results The construct stiffness decreased dramatically under PSD conditions. The dual-canScrew (154.3 ± 9.3 N/mm), sub-Plate (147.1 ± 10.2 N/mm), and sub-PedRod (133.8 ± 8.0 N/mm) groups showed better ability to restore intact stability than the other groups (p < 0.05). Regarding regional stability, only single-plate fixation provided unexpected regional stability with a diastasis of 2.1 ± 0.2 mm (p < 0.001) under a compressive load. Under a rotational load, the single-crsPlate group provided better regional angular stability (0.31° ± 0.03°, p < 0.001). Stress concentrations occurred in the single-Plate, sub-Plate, and sub-PedRod groups. The maximum von Mises stress was observed in the single-plate group (1112.1 ± 112.7 MPa, p < 0.001). Conclusion The dual-canScrew fixation device offers ideal outcomes to maintain stability and prevent failure biomechanically. The single-crsPlate and dual-Plate methods effectively improved single-Plate device to enhance regional stability and disperse stresses. The subcutaneous fixation devices provided both anterior pelvic ring stability and pubic symphysis strength.

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A biomechanical cadaver comparison of suture button fixation to plate fixation for pubic symphysis diastasis

Cited by 13 publications

References 27 publications

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis

Biomechanical evaluation of seven fixation methods to treat pubic symphysis diastasis using finite element analysis

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