Does Lumbopelvic Fixation Add Stability? A Cadaveric Biomechanical Analysis of an Unstable Pelvic Fracture Model

Jazini, Ehsan; Klocke, Noelle; Tannous, Oliver; Johal, Herman; Hao, John; Salloum, Kanaan; Gelb, Daniel E.; Nascone, Jason W.; Belin, Eric; Hoshino, C Max; Hussain, Mir; O’Toole, Robert V.; Bucklen, Brandon; Ludwig, Steven C.

doi:10.1097/bot.0000000000000703

Cited by 30 publications

(20 citation statements)

References 22 publications

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“…The 6 degrees of freedom of the bilateral ischial tuberosity were constrained [11,12]. A uniformly distributed load (load speed, 10 N/s) of 600 N was applied vertically downward on the upper surface of S1 [13] to calculate model displacement and stress.…”

Section: Analysis Of Model Displacement and Stressmentioning

confidence: 99%

Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures

et al. 2020

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Departmental sources Background:Despite the development of minimally invasive techniques for pelvic fractures, performing minimally invasive surgery for Tile C3 pelvic fractures remains challenging. Thus, we propose use of anterior ring internal fixation combined with sacroiliac screw fixation for Tile C3 pelvic fractures. Material/Methods:A normal pelvic finite element model (model 1) was established. Two-screw, three-screw, and four-screw anterior ring internal fixators and plate combined with sacroiliac screw Tile C3 pelvic fracture models (models 2, 3, 4, and 5, respectively) were also established. A vertical load of 600 N was applied on S1. The distribution of displacement and stress in the standing and sitting positions was compared. Results:Models 2, 3, 4, and 5 can provide effective fixation. Compared with model 1, in the erect position, the maximum displacement of models 2, 3, 4, and 5 increased by 66.51%, 65.36%, 35.16%, and 35.47% and the maximum stress increased by 201.78%, 130.65%, 100.82%, and 99.03%, respectively. Compared with model 1, in sitting position, the maximum displacement of models 2, 3, 4, and 5 increased by 9.1%, 11.04%, 5.57%, and 8.59% and the maximum stress increased by 157.73%, 118.02%, 98.32%, and 93.16%, respectively. Conclusions:Anterior ring internal fixators combined with sacroiliac screws can effectively fix Tile C3 pelvic fractures.

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Section: Analysis Of Model Displacement and Stressmentioning

confidence: 99%

Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures

et al. 2020

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“…Beginning with simple percutaneous iliosacral screws for uncomplicated sacrum fractures, the H-shaped sacrum fracture requires sophisticated spinopelvic stabilization with pedicle screws in L4 or L4 and L5 and a sacral-alar-iliac fixation, both of which are connected with a vertical rod. With such a bilateral construct, the applying vertical forces are adequately addressed ( Jazini et al, 2017a ). The armamentarium of spinal surgery also contains the possibility of adding a cross connector to these bilateral rods.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from that, the complex traumatic sacrum fracture beside the rare entity of spinopelvic discontinuation in severe trauma patients depict utterly different fracture patterns. The traumatic central sacrum fractures are a condition that can be stated generally rare with an incidence of 2 per 100, 000 ( Beckmann and Chinapuvvula, 2017 ), while within pelvic trauma patients, the unstable sacral fracture has an incidence of 17–30% ( Jazini et al, 2017a ). Regarding the operative treatment, complex fractures cannot adequately be reduced by only iliosacral screws but need vertical support and the neutralization of shearing forces ( Guerado et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…While the biomechanically favorable impact of the lumbopelvic stabilization has been proven, the addition of a CC has not been biomechanically assessed to date. Nonetheless, there is reliable data that bilateral stabilization is necessary to immobilize the sacroiliac joint ( Jazini et al, 2017a ; Lindsey et al, 2018 ). In theory, after proximal L5 fixation, shearing and rotating forces could be addressed by cross connectors ( Guerado et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Effects of a Cross Connector in Sacral Fractures – A Finite Element Analysis

Gierig

Liu

Weiser

et al. 2021

Front. Bioeng. Biotechnol.

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Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model).Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration.Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001).Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.

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“…This even strengthens our conclusion that adhering to the inlet–outlet safe zone as defined here would allow surgeons to safely insert more than one screw in S1. This is especially important since numerous studies have shown that multiple sacral screws provide the strongest biomechanical fixation …”

Section: Discussionmentioning

confidence: 99%

Simple mathematical model of sacroiliac screws safe-zone-Easy to implement by pelvic inlet and outlet views

et al. 2016

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Percutaneous sacral screw fixation is the mainstay of posterior pelvic ring fixation. This study quantifies the accuracy of fluoroscopic screw placement using post-operative CT scans and redefines the fluoroscopic safe zone using a mathematical calculation obtained from Inlet and outlet images. The authors hypothesized that a mathematical calculation of screw placement within the ala will improve accuracy of screw placement. A retrospective review of consecutive patients admitted to a level 1 trauma center with pelvic fractures fixed with iliosacral screws from January 2011 to December 2014 was performed. Accuracy of screw placement was determined by comparing fluoroscopy to post-operative CT scans. A mathematical calculation of screw position within the sacral ala was applied to determine assess screw position and compared to CT findings. Ninety-four patients with 156 screws met inclusion criteria, of which 50 (32.0%) had a cortical breech on CT. The sensitivity and specificity of the inlet-outlet safe zone using mathematical calculation were 97.1% and 84.0%, respectively. The positive and negative predictive values were 92.7% and 93.3%, respectively. Overall accuracies of the radiographic inlet-outlet and lateral safe zones were 92.9% and 70.0%, respectively (p-value = 0.004). Sacral dysmorphism was not found to be associated with sacral cortical breech. A Simple mathematical calculation (screw position relative to percentage of bone width) on the inlet-outlet provides an accurate way to predict the accuracy of sacroiliac screws. The method is easy to implement, part of the surgery work-flow, and provides higher accuracy than relying on subjective interpretation of inlet, outlet, and lateral images. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1478-1484, 2017.

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Does Lumbopelvic Fixation Add Stability? A Cadaveric Biomechanical Analysis of an Unstable Pelvic Fracture Model

Cited by 30 publications

References 22 publications

Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures

Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures

Biomechanical Effects of a Cross Connector in Sacral Fractures – A Finite Element Analysis

Simple mathematical model of sacroiliac screws safe-zone-Easy to implement by pelvic inlet and outlet views

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