A novel internal fixation method for open book injuries of the pubic symphysis— A biomechanical analysis

Fritz, Tobias; Mettelsiefen, Laura; Strobel, Friedemann; Braun, Benedikt J.; Herath, Steven C.; Hopp, Sascha; Histing, Tina; Pohlemann, Tim; Pizanis, A.

doi:10.1016/j.clinbiomech.2020.105009

Cited by 7 publications

(11 citation statements)

References 32 publications

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“…This is one possible reason why crescent fractures [ 18 ] can occur during treatment. The stress of the SPRP and IQSBP models was mainly distributed on the screws close to the pubic symphysis, which may be one reason for complications of internal fixation of the pubic symphysis, such as screw loosening, pull-out, or breakage, in clinical practice [ 19 , 20 ]. The stress of the SQSBP model was also at the upper pubic ramus, at the junction where the internal fixation instrumentation extended to the quadrilateral surface of the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

et al. 2022

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Background Elderly acetabular fractures are one of the more difficult types of fractures to resolve. For patients at this age, the more common type of fracture is comminuted. How to better fix this type of fracture has always been an issue of concern. This study was performed to observe the mechanical properties of different internal fixation methods used in treating elderly acetabular fracture patients. Methods A model of a comminuted acetabular fracture in osteoporosis was established, consisting of an anterior column–posterior hemitransverse fracture with disruption of the quadrilateral surface. Fixation of the acetabular fracture model using a reconstruction plate and Union Plates was simulated. For the different internal fixation methods, static and transient modal analyses were performed under different loads, with an action time of 0.21 s and an analysis time of 0.7 s. The stress of the model was observed in the static analysis, and the displacement of the nodes and the entire model in the U1 direction was observed in the transient modal analysis. Results In the static analysis, the stress of the osteoporosis model, the suprapectineal pelvic reconstruction plate model, the infrapectineal quadrilateral surface buttress plate model, and the suprapectineal quadrilateral surface buttress plate model were 42.62 MPa, 37.49 MPa, 44.39 MPa, and 46.15 MPa, respectively. The stress was mainly distributed near the suprapubic branch. The corresponding displacement in the U1 direction was 0.1500 mm, 0.1020 mm, 0.0836 mm, and 0.0990 mm, respectively. In the transient modal analysis, there was a significant difference in displacement between the different models (P < 0.05). When different loads were applied with the same fixation method, there was no significant difference in model displacement (P > 0.05). Conclusion Static and transient modal analyses show that the infrapectineal quadrilateral surface buttress plate or the suprapectineal quadrilateral surface buttress plate has an advantage in maintaining the stability of fracture fragments when fixing comminuted acetabular fractures in elderly individuals. The infrapectineal quadrilateral surface buttress plate also presents better biomechanical results.

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Section: Discussionmentioning

confidence: 99%

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

et al. 2022

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“…Stuby et al tested a custom made fixation device for flexible fixation and proofed superior stability 50 . In 2020 Fritz et al evaluated symphyseal fixation by polyaxial pedicle screws and revealed superior strength compared to plating 51 . Currently, none of these alternative fixation techniques is in widespread use but it demonstrates the continues quest for a new technique.…”

Section: Discussionmentioning

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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“…For biomechanical testing, standardized fractures were generated by osteotomies on artificial synthetic pelvis models, as described in previous studies [ 21 , 34 ]. This model has limitations due to missing ligaments, however artificial pelvises allow a very standardized sample group which overcomes the nearly uncountable variations in bone quality seen in human anatomical specimens [ 22 , 25 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of an infra-acetabular screw for anatomically shaped three-dimensional plate or standard plate designs in acetabulum fractures: a biomechanical analysis

Graul

Marintschev

Pizanis

et al. 2021

Eur J Trauma Emerg Surg

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Background Various plate shapes and implant configurations are used for stabilization of acetabulum fractures via anterior approaches. Little is known about the biomechanical stability of a two-dimensionally shaped “conventional” plate (“J-Plate”—JP) in comparison to three-dimensionally shaped plate configurations (3DP). In addition, the augmentary effect of an infra-acetabular lag-screw (IACS) fixation for anterior column and posterior hemi-transverse acetabulum fractures has not been clarified in comparison of JP and 3DP constructs. This study analyzed the difference between the biomechanical stability of JP compared to 3DP and the role of an IACS in a standardized acetabular fracture model in a single-leg stance loading configuration. Methods In an artificial bone substitute pelvis model (Synbone© Malans, Switzerland), a typical and standardized fracture pattern (anterior column and posterior hemi-transverse) was created with osteotomy jigs. After anatomic reduction the stabilization was performed using JP or 3DP. Eight pelvises per group were axially loaded in a single-leg stance model up to 400 N. After the load cycle, an additional infra-acetabular screw was placed and the measurement repeated. Fragment displacement was recorded by an optical tracking system (Optitrack Prime 13®, Corvallis, USA). Results In the pure placement, 3DP provided significantly superior stability when compared to JP. Augmentation of JP by IACS increased the stability significantly, up to the level of 3DP alone, whereas augmentation of the 3DP did not result in further increase of overall stability. Conclusion The anatomically shaped plate alone provides a superior biomechanical stability in fixation of an anterior column and posterior hemi-transverse fracture model. In a JP fixation the augmentation by IACS provides similar strength as the anatomically shaped 3DP. By use of the anatomically shaped 3DP the need of a clinically risky application of IACS might be avoidable. Level of evidence IV, Experimental study.

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A novel internal fixation method for open book injuries of the pubic symphysis— A biomechanical analysis

Cited by 7 publications

References 32 publications

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

Trans-obturator cable fixation of open book pelvic injuries

The effect of an infra-acetabular screw for anatomically shaped three-dimensional plate or standard plate designs in acetabulum fractures: a biomechanical analysis

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