Biomechanical comparison of three minimally invasive fixations for unilateral pubic rami fractures

Zhao, Yong; Ma, Yupeng; Zou, Dequan; Sun, Xiujiang; Gong, Chengliang; Lian, Wei; Dong, Shengjie; Zhao, Yuchi; Qu, Wenqing; Wu, Hao

doi:10.1186/s12891-020-03604-8

Cited by 5 publications

(7 citation statements)

References 13 publications

(16 reference statements)

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“…Nevertheless, the dimension and trajectory of the cannulated screw must be considered with respect to morphological variations of the superior pubic ramus. Generally speaking, cannulated screws with a long length (>100 mm) and a small diameter (<6.5 mm) are no longer available owing to the pro risk of breakage 33 . However, even with a 6.5 mm screw, some patients did not have enough acetabular and parasymphyseal areas for safe placement 11 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case–control study

Xia,

Jiang,

Tao

et al. 2024

International Journal of Surgery

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Object: A novel technique, percutaneous elastic stable intramedullary nail fixation (ESIN), proposed by our team for the treatment of anterior pelvic ring injury. Finite element analysis and retrospective case-control study were used to compare biomechanical properties and clinical outcomes between ESIN and other techniques. Methods: Four groups of finite element models of pelvic anterior ring injury were simulated, including ESIN (model A), retrograde transpubic screw fixation (RTSF, model B), subcutaneous internal fixator (model C), and external fixator (model D), and a vertical downward load of 500 N was applied to the S1 vertebral endplate. Stress and displacement distributions of intact pelvis, displacement distributions of pubic fracture fragments, and stress distributions of fixation devices were analyzed. Then 31 patients with anterior pelvic ring injury (15 in the ESIN group and 16 in the RTSF group) were reviewed. Clinical outcomes were evaluated at the final follow-up. Postoperative complications were also recorded. Results: Under 500N loading, the intact stability of the pelvis was compared as follows: model B (20.58 mm, 121.82 MPa), model A (20.80 mm, 129.97 MPa), model C (22.02 mm, 141.70 MPa), and model D (22.57 mm, 147.06MPa). The regional stability of superior pubic ramus was compared as follows: model B (9.48 mm), model A (10.16 mm), model C (10.52 mm), and model D (10.76 mm). All 31 patients received follow-up at least 12 months post-surgery (range 12–20 months). Age, sex, injury mechanism, fracture type, time between the injury and operation, American Society of Anesthesiologists score, intraoperative blood loss, hospital stay, follow-up period, time to union and Majeed scores did not differ significantly between the two groups (P>0.05). However, the differences in the duration of unilateral surgery, unilateral intraoperative fluoroscopy and one-time success rate were significant (P<0.05). Conclusions: With sufficient biomechanical stability and minimally invasive advantage, the percutaneous technique using ESIN can be used to successfully treat anterior pelvic ring injuries. In addition, advantages over RTSF include a shorter duration of surgery, reduced requirement for intraoperative fluoroscopy and a higher one-time success rate. ESIN therefore constitutes a good alternative to RTSF.

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Section: Discussionmentioning

confidence: 99%

Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case–control study

Xia,

Jiang,

Tao

et al. 2024

International Journal of Surgery

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“…In pelvic surgery, prioritizing the treatment of posterior pelvic ring injuries takes precedence because maintaining stability in the posterior pelvic ring is essential [1][2][3]. While osteosynthesis of the anterior pelvic ring is generally regarded as less critical compared to its posterior counterpart, suboptimal reduction quality and stability may contribute to a reduction in the functional performance of patients [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Closed Versus Open Reduction Techniques in Straddle Fractures: A Retrospective Analysis of 69 Patients

Yu,

Lai,

Chen

et al. 2024

Preprint

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Background Osteosynthesis techniques for addressing straddle fractures include closed reduction and fixation (CRF) and open reduction and fixation (ORF). Although CRF offers the advantage of being a minimally invasive surgery, ORF ensures precise reduction and secure fixation. The optimal surgical approach, whether employing CRF or ORF, to achieve superior osteosynthesis outcomes remains uncertain. This study aimed to compare the perioperative characteristics of the two methods and identify an optimal treatment approach tailored to each clinical indication. Methods We performed a retrospective analysis of patients with pelvic ring injuries at a single trauma center admitted between 2016 and 2021. Among this cohort, 69 patients with straddle fractures, with or without posterior pelvic ring injuries, were identified. The patients were categorized into two groups based on the treatment protocol: the CRF and ORF groups. Preoperative conditions, intraoperative features, and radiological outcomes were systematically compared and analyzed. Results A total of 69 patients with 138 superior pubic rami fractures underwent surgical treatment using either closed (57 superior pubic rami) or open (81 superior pubic rami) methods. Application of CRF significantly prevented fractures in Nakatani zone I (P = 0.003). ORF was employed for segmental fractures of the pubic ramus (P = 0.03) and fractures with greater displacement in the axial plane (P = 0.03). Additionally, ORF resulted in a more symmetric pelvic reduction according to the Lefaivre criteria (P = 0.003). Conclusion Both CRF and ORF demonstrated the ability to achieve satisfactory radiological outcomes in straddle fractures. The use of an established treatment protocol can assist surgeons in making informed decisions regarding the optimal treatment approach. Level of Evidence Therapeutic III

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“…Through mechanical experiments, researchers have confirmed that transpubic screws can maintain the stability of the anterior ring of the pelvis 8 . Based on its advantages of good mechanical stability and low trauma, transpubic screws are considered to be the best surgical method for pubic fracture 9 . An anatomic study of 260 transpubic screw corridors found that all males were able to accommodate the insertion of screws with a diameter of 6.5 mm, while 15% of females were unable to accommodate the insertion of screws with a diameter of 6.5 mm 10,11 .…”

Section: Introductionmentioning

confidence: 99%

“… 8 Based on its advantages of good mechanical stability and low trauma, transpubic screws are considered to be the best surgical method for pubic fracture. 9 An anatomic study of 260 transpubic screw corridors found that all males were able to accommodate the insertion of screws with a diameter of 6.5 mm, while 15% of females were unable to accommodate the insertion of screws with a diameter of 6.5 mm. 10 , 11 Most men could even accommodate the insertion of a 7.3 mm diameter screw.…”

Section: Introductionmentioning

confidence: 99%

Navigation Template Design and the Anatomic Measurement for Anterograde Transpubic Screws

Shen

Deng

et al. 2022

Orthopaedic Surgery

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Objective: For pelvic ring fractures, screw fixation became a popular technique for its good biomechanical performance. The safe insertion of anterograde the transpubic screw is important for patients with anterior pelvic ring fractures. This paper is to research the anatomical parameters of the anterograde transpubic screw corridor and evaluate the safety of anterograde transpubic screw placement assisted by the assembled navigation template.Methods: Fifty subjects with normal pelvic, 25 men and 25 women, age from 20 to 60 were enrolled, and their ilium were 3D reconstructed. The ilium was divided into zone I, zone II and zone III. Zone I and zone III was defined as medial and lateral to the obturator foramen, respectively. Zone II is located between zones I and III. The corridor A is formed by zone I and zone II and corridor B is formed by zone I, zone II and zone III. The diameter and length of the inner circle, the distance from the center of the inner circle to the posterior superior and to the inferior iliac spine of corridor A and corridor B were measured, respectively. Nine patients with pelvic fractures underwent anterograde transpubic screw and transverse sacroiliac screw placement assisted by the assembled navigation template and were retrospectively analyzed. Operation time, blood loss, incision length and fluoroscopy times were recorded. Grading score and Matta score were evaluated after surgery. Results:In the 50 subjects, the diameter of corridor A was 11.16 AE 2.13 mm, and that of corridor B was 8.54 AE 1.52 mm. The length of corridor A was 86.39 AE 9.35 mm, and that of corridor B was 117.05 AE 5.91 mm. The surface distance from the screw entry point to the posterior superior iliac spine in corridor A was 109.31 AE 11.06 mm, and that in corridor B was 127.86 AE 8.23 mm. The surface distance from the screw entry point to the posterior inferior iliac spine in corridor A was 91.16 AE 10.34 mm, and that in corridor B was 106.92 AE 7.91 mm. A total of 18 sacroiliac transverse screws and 11 anterograde transpubic screws were inserted assisted by assembled navigation templates for nine patients. The average operation time was 108.75 AE 25.71 min, the blood loss was 141.11 AE 50.21 ml, the incision length was 14 AE 4.62 cm, and the intraoperative fluoroscopy was 17.89 AE 4.01 times. Conclusion:Transpubic screw corridor can be obtained by 3D reconstruction. For the majority of patients, the anterograde pubic ramus corridor accommodated a 6.5 mm diameter screw. It is safe to use anterograde transpubic screw placement assisted by an assembled navigation template.

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Biomechanical comparison of three minimally invasive fixations for unilateral pubic rami fractures

Cited by 5 publications

References 13 publications

Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case–control study

Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case–control study

Comparative Evaluation of Closed Versus Open Reduction Techniques in Straddle Fractures: A Retrospective Analysis of 69 Patients

Navigation Template Design and the Anatomic Measurement for Anterograde Transpubic Screws

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