Biomechanical Study of Transsacral-transiliac Screw Fixation Versus Lumbopelvic Fixation and Bilateral Triangular Fixation for “H”- and “U”-type Sacrum Fractures With Traumatic Spondylopelvic Dissociation: a Finite Element Analysis Study

Ye, Peng; Zhang, Gongzi; Zhang, Shuwei; Ji, Xiaotong; Li, Junwei; Du, Chengbin; Zhao, Wen; Zhang, Lihai

doi:10.21203/rs.3.rs-472072/v1

Cited by 3 publications

(2 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The core concept was to control the shearing and rotation disability of the sacrum. Our previous study [29] suggested the following: (1) If the fracture type has no obvious displacement or kyphosis displacement, and the fracture is accompanied by relatively stable support (such as Type Ia or Ib), double penetrating screw fixation should be recommended; (2) if there is unilateral sacroiliac joint separation (such as type II or III), penetrating screw combined with sacroiliac lag screw fixation should be used; (3) if the fracture type is anterior flexion displacement (such as Type Ic) and the fracture is unstable because of lack of support, regardless of reduction or not, spondylopelvic fixation should be recommended; and (4) if lumbosacral displacement occurs (such as Type Id), lumbosacral fusion fixation should be used (Table 4). The transsacral-transiliac penetration screws [6] offer a long arm of force for fixation; they can disperse the load and reduce the stress of the tip of screws, thus decreasing the risk of dislocation, and can resist the rotation and shearing stress [30][31][32][33].…”

Section: Typementioning

confidence: 98%

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy

Shi

Zhang

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

Background Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD. Methods Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications. Results The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points. Conclusion The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.

show abstract

Section: Typementioning

confidence: 98%

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy

Shi

Zhang

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…57 Compared with transiliac-transsacral screws, triangular osteosynthesis is also biomechanically superior at tolerating anteflexion, and rotational forces indicating this technique may be superior in highly unstable injuries or in patients where the physician is concerned about future fracture displacement. 58 It has been suggested that triangular osteosynthesis is also more useful in the setting of sacral comminution, poor bone quality, or neurological dysfunction. 59 Historically, this technique was significantly more invasive than isolated transiliactranssacral screws, with higher rates of blood loss, as well as wound and instrumentation complications.…”

Section: Spinopelvic Fixation/triangular Osteosynthesismentioning

confidence: 99%

Management of C0 Sacral Fractures Based on the AO Spine Sacral Injury Classification

Lambrechts

Schroeder

Conaway

et al. 2022

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.

show abstract

Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review

Beucler,

Tannyeres,

Dagain

2023

Asian Spine J

View full text Add to dashboard Cite

Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure.

show abstract

Biomechanical Study of Transsacral-transiliac Screw Fixation Versus Lumbopelvic Fixation and Bilateral Triangular Fixation for “H”- and “U”-type Sacrum Fractures With Traumatic Spondylopelvic Dissociation: a Finite Element Analysis Study

Cited by 3 publications

References 15 publications

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy

Management of C0 Sacral Fractures Based on the AO Spine Sacral Injury Classification

Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review

Contact Info

Product

Resources

About