Biomechanical Comparison of Posterior Pelvic Ring Fixation

Yinger, Kent E.; Scalise, Jason J.; Olson, Steven A.; Bay, Brian K.; Finkemeier, Christopher G.

doi:10.1097/00005131-200308000-00002

Cited by 179 publications

(133 citation statements)

References 16 publications

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“…Multiple treatment modalities are available with specific advantages and disadvantages, including the experience of the treating surgeon [26]. The stiffness of constructs with various posterior pelvic ring fixation devices is reportedly similar [42]. Several studies suggest anatomic reduction relates to decreased pain symptoms during activities of daily living [26,31,33].…”

Section: Discussionmentioning

confidence: 99%

“…However, some surgical approaches for treatment of unstable posterior pelvic ring injuries have disadvantages: (1) anterior plate fixation of the sacroiliac joint places the L5 root at risk during dissection and implant placement, and tremendous blood loss [2,8]; (2) posterior fixation with transiliac sacral bars that bridge the contralateral sacroiliac joint and cause discomfort in thin patients owing to prominent implants [4]; (3) posterior plate osteosynthesis (open or in a minimally invasive percutaneous technique), intraoperatively, correct bending of the plates is sometimes difficult to achieve and an extended approach for hardware removal might be necessary even in initial percutaneous techniques [19]; and (4) screw fixation of the sacroiliac joint (open or in a percutaneous technique) for which an experienced surgeon and high intraoperative fluoroscopic quality are essential [1,30,34]. One mechanical study suggests there are no differences in secondary fracture displacement among these techniques, and the best treatment remains controversial [42].…”

Section: Introductionmentioning

confidence: 99%

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A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Open reduction and stabilization of dorsal pelvic ring injuries is accompanied by a high rate of soft tissue complications. Minimally invasive techniques have the potential to decrease soft tissue trauma, but the risk of iatrogenic nerve and vessel damage through the reduced surgical exposure should be considered. We treated these injuries using a transiliac internal fixator (TIFI) in a minimally invasive technique characterized by implantation of a pedicle screw and rod system, bridging the sacroiliac joints and the sacral area. Questions/purposes We asked whether (1) we could achieve anatomic restoration with the device, (2) specific complications were associated with this minimally invasive approach (particularly enhanced intraoperative blood loss, soft tissue complications, and iatrogenic neurovascular damage), and (3) function 3 years after trauma was comparable to that of established methods. Methods We retrospectively reviewed 67 patients with dorsal pelvic injuries during a 7-year period. We evaluated the (1) reduction by grading the maximal displacement measured with three radiographic views, (2) the complications during the observation period, and (3) the function with a validated questionnaire (Pelvic Outcome Score) in all but five patients at least 3 years after trauma (mean, 37 months; range, 36-42 months). Results At last followup we observed a secondary fracture displacement greater than 5 mm in one patient. The intraoperative blood loss was less than 50 mL in all patients. No neurovascular lesions occurred owing to implantation. Four patients had wound infections, one had loosening of a single pedicle screw, and one had an iatrogenic screw malpositioning. Thirty-five of the 62 patients achieved Pelvic Outcome Scores of either a maximum score or 6 of 7 points. Conclusion Our observations suggest TIFI is a reasonable alternative to other established fixation devices for injuries of the dorsal pelvic ring with minor risks of major blood loss or iatrogenic neurovascular damage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…While many biomechanical studies show that the various stabilization systems exhibit similar stiffness [14], it might be advantageous to use a method with minor risks during surgical implantation. In a preliminary clinical study the TIFI has proven to be a system with a low complication rate, as far as iatrogenic vessel or nerve damage [16,23].…”

Section: Discussionmentioning

confidence: 99%

“…This approach is currently aided by CT scans or alternative navigation devices [13]. Yinger et al was able to demonstrate in a biomechanical setting [14] that many of these currently used techniques show no discernible improvement with regard to stiffness; deciding upon the best method for treatment is therefore a multifactorial decision-making process.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical analysis of a transiliac internal fixator

Dienstknecht

Berner

Lenich

et al. 2011

International Orthopaedics (SICOT)

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Purpose We evaluated the biomechanical characteristics of the transiliac internal fixator (TIFI) as compared to two wellestablished methods of internal posterior pelvic ring fixation. Methods Six freshly frozen human pelves were used for simulated single-leg stance loading of an AO type C injury model (pubic symphysis diastasis and unilateral sacroiliac joint disruption). The symphysis rupture was stabilized with a dynamic compression plate. Afterwards the three internal stabilization systems (TIFI, iliosacral screws and ventral plate osteosynthesis) were analysed. Fragment movement was measured in a contact-free manner with a stereophotometric infrared system. Results No significant differences in the three-dimensional deformation tolerated by the TIFI as compared to the other internal fixation systems were found. Conclusions The transiliac internal fixator provides the same biomechanical stability as the other reference implants tested. We suggest the use of this device as a suitable alternative to the other implants.

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“…Furthermore, a substantial number of patients continue to suffer chronic posterior pelvic pain despite near anatomical reductions [18,19,25]. Minimally invasive transiliac plate osteosynthesis may be an alternative to SI screw fixation and appears to be biomechanically comparable [1,29]. We evaluated outcome, complications and surgical and fluoroscopy time for patients treated with transiliac locked compression plate osteosynthesis for posterior pelvic-ring injuries.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate

Kobbe

Hockertz

Sellei³

et al. 2011

International Orthopaedics (SICOT)

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Purpose Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic-ring injuries; however, this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. This study evaluates whether minimally invasive transiliac locked compression plate stabilisation may be an alternative to sacroiliac screw fixation in unstable posterior pelvic-ring injuries. Methods We performed a retrospective analysis of patients with unstable pelvic-ring injuries treated with a transiliac locked compression plate at a level I trauma centre. Outcome evaluation was assessed using the Pelvic Outcome Score and analysis of complications, intraoperative fluoroscopic time, and duration of the surgical procedure. Results Twenty-one patients were available for follow-up after an average of 30 months. The main findings were as follows: Overall outcome for the Pelvic Outcome Score was excellent in 47.6% (ten patients), good in 19% (four patients), fair in 28.6% (six patients), and poor in 4.8% (one patient). Average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 s. No iatrogenic neurovascular injuries were observed. Conclusion Minimally invasive transiliac locked compression plate stabilisation may be a good alternative to sacral screw fixation because it is quick, safe and associated with a good functional outcome.

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Biomechanical Comparison of Posterior Pelvic Ring Fixation

Abstract: Under conditions of maximal instability with similar material properties between specimens, differences in stiffness of posterior pelvic ring fixation can be demonstrated. The choice of which method to use is multifactorial.

Cited by 179 publications

References 16 publications

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Biomechanical analysis of a transiliac internal fixator

Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate

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