Biomechanical analysis of the fixation systems for anterior column and posterior hemi-transverse acetabular fractures

Lei, Jianyin; Dong, Pengfei; Li, Zhiqiang; Zhu, Feng; Wang, Zhi Hua; Cai, Xianhua

doi:10.1016/j.aott.2017.02.003

Cited by 30 publications

(32 citation statements)

References 25 publications

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“…For custom pelvic implants, fixation design is important, considering that the fixation secures the pelvic implants to the remaining bones, and should bear substantial loads as well [9]. A double column plating or a single column plating combined with lag screws has been commonly utilized to fix pelvic bones.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of a New Fixation Type in 3D-Printed Periacetabular Implants using a Finite Element Simulation

et al. 2019

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Pelvic implants require complex geometrical shapes to reconstruct unusual areas of bone defects, as well as a high mechanical strength in order to endure high compressive loads. The electron beam melting (EBM) method is capable of directly fabricating complex metallic structures and shapes based on digital models. Fixation design is important during the 3D printing of pelvic implants, given that the fixation secures the pelvic implants to the remaining bones, while also bearing large amounts of the loads placed on the bone. In this study, a horseshoe-shaped plate fixation with a bridge component between two straight plates is designed to enhance the mechanical stability of pelvic implants. The aim of this study is to investigate the biomechanics of the horseshoe-shaped plate fixation in a 3D-printed pelvic implant using a finite element (FE) simulation. First, computed tomography (CT) scans were acquired from a patient with periacetabular bone tumors. Second, 3D FE implant models were created using the patient’s Digital Imaging and Communications in Medicine (DICOM) data. Third, a FE simulation was conducted and the stress distribution between a conventional straight-type plate model, and the horseshoe-shaped plate model was compared. In both of the models, high-stress regions were observed at the iliac fixation area. In contrast, minimal stress regions were located at the pubic ramus and ischium fixation area. The key finding of this study was that the maximal stress of the horseshoe-shaped plate model (38.6 MPa) was 21% lower than that of the straight-type plate model (48.9 MPa) in the iliac fixation area. The clinical potential for the application of the horseshoe-shaped plate fixation model to the pelvic implant has been demonstrated, although this is a pilot study.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of a New Fixation Type in 3D-Printed Periacetabular Implants using a Finite Element Simulation

et al. 2019

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“…In our previous research, we reported a new fixation technique called DAPSQ for complex acetabular fractures with quadrilateral plate involvement and obtained satisfactory clinical results 4 . Biomechanical studies have investigated the biomechanical stability of DAPSQ devices [19][20] . As described earlier, the DAPSQ plate was a simple and ingenious design based on the traditional reconstruction plate and specially shaped, just like a "curl" or "Moebius strip."…”

Section: Key Surgical Technology Of Double-column Acetabular Fracturesmentioning

confidence: 99%

Personalized Three‐Dimensional Printed Anterior Titanium Plate to Treat Double‐Column Acetabular Fractures: A Retrospective Case‐Control Study

Shao

Song

et al. 2020

Orthopaedic Surgery

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Objective To compare the clinical efficacy and safety of a personalized three‐dimensional (3D) printed dynamic anterior plate–screw system for the quadrilateral area (DAPSQ) titanium plate and a traditional DAPSQ reconstruction plate in the treatment of double‐column acetabular fractures. Methods This was a retrospective case‐control study. From May 2014 to January 2018, 43 patients with double‐column acetabular fractures underwent open reduction and internal fixation. Among these, 20 cases were fixed with a 3D printed DAPSQ plate (3D printed group) and 23 cases were fixed with a DAPSQ reconstruction plate (control group). The 3D printed group comprised 15 men and 5 women, with an average age of 50.1 ± 8.2 years. The control group comprised 16 men and 7 women, with an average age of 51.0 ± 8.6 years. The evaluation index included the surgical data (i.e. blood loss, operating time, duration of hospital stay, and intraoperative and postoperative complications), position and length of implants, reduction quality, hip function, and related complications. The reduction quality was evaluated using the Matta scoring standard and hip function was evaluated using the modified Merle d’Aubigné score. Results A total of 43 patients met the inclusion criteria. The mean postoperative follow up was 35.2 months in the 3D printed group and 36.9 months in the control group. There were no significant group differences in demographic data between the two groups. The position and length of the 3D printed implants were generally in accord with preoperative planning using a 3D pelvic model. Patients in the 3D printed group had significantly shorter operation time (223.2 vs 260.5 min, P < 0.05) and less intraoperative blood loss (930.4 vs 1426.1 mL, P < 0.05) compared to the control group. Anatomic, imperfect, and poor reduction was obtained in 13, 5, and 2 cases in the 3D printed group, respectively, and was obtained in 12, 8, and 3 cases in the control group. The modified Merle d’Aubigné scores were excellent in 11 cases, good in seven cases, and fair in two cases in the 3D printed group. They were excellent in 11 cases, good in eight cases, fair in three cases, and poor in one case in the control group. The reduction quality and hip function did not differ within the groups (P > 0.05). The general complication rate in the 3D printed group and the control group was 15% and 26.1%, respectively, but the difference between the two groups was not statistically significant. Conclusion Use of a personalized 3D printed DAPSQ plate has potential advantages in reducing the operation time and blood loss during the treatment of double‐column acetabular fractures.

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“…A number of studies have focused on the biomechanical consequences of acetabular fracture [28][29][30][31][32]. These studies can be divided into those focusing on.…”

Section: Biomechanical Consequences Of Acetabular Fracturementioning

confidence: 99%

“…Several studies have focused on the alteration of contact area and stresses in the joint as a result of the fracture [28][29][30][31][32]. All fracture patterns showed a change from a uniform contact pattern to one of increased contact area and peak pressures in the superior acetabulum.…”

Section: Intra-articular Contact Characteristicsmentioning

confidence: 99%

Surgical Anatomy of Acetabulum and Biomechanics

Sharma¹,

Mathur²

2020

Essentials in Hip and Ankle

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Both column acetabular fractures are challenging articular injuries. Majority of them are treated operatively. The concept of "secondary congruence" was introduced by Letournel. Despite this, biomechanical data on secondary congruence indicate that nonoperative treatment leads to an increase in peak pressures in the supra-acetabular region with the potential risk of developing posttraumatic degenerative osteoarthritis. Operative management is therefore justified. A cohort of 10 patients having both column (anterior and posterior) acetabular fractures managed using bicolumnar plating between Jan 2016 and Dec 2017 were enrolled in the study and were analyzed during follow-up period. Eighty percent of the patients had excellent to good result. Average postoperative score was 85.7. Assessment was done using Modified Harris Hip score.

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Biomechanical analysis of the fixation systems for anterior column and posterior hemi-transverse acetabular fractures

Cited by 30 publications

References 25 publications

Biomechanical Evaluation of a New Fixation Type in 3D-Printed Periacetabular Implants using a Finite Element Simulation

Biomechanical Evaluation of a New Fixation Type in 3D-Printed Periacetabular Implants using a Finite Element Simulation

Personalized Three‐Dimensional Printed Anterior Titanium Plate to Treat Double‐Column Acetabular Fractures: A Retrospective Case‐Control Study

Surgical Anatomy of Acetabulum and Biomechanics

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