Does Posterior Fixation of Partially Unstable Open-Book Pelvic Ring Injuries Decrease Symphyseal Plate Failure? A Biomechanical Study

Bledsoe, J. Gary; Moed, Berton R.

doi:10.1097/bot.0000000000001083

Cited by 19 publications

(18 citation statements)

References 23 publications

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“…The posterior sacroiliac ligament, also known as the dorsal sacroiliac ligament, divides into shallow and deep layers. The posterior sacroiliac ligament and the interosseous ligament constitute the sacroiliac ligament complex, which forms the main mechanical resistance at the back of the sacroiliac joint [6][7][8][9][10][11][12][13][14][15][16]. Tile et al conducted mechanical experiments, which confirmed that if the posterior sacroiliac ligament complex remains intact, even if other pelvic ligaments ruptured, there would be no backward and up-down displacement of the hemipelvis [14].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we stimulated and modified two different APC injury models based on the articles reported in recent years [7], and randomly divided the specimens into two groups, and made two kinds of pelvic external rotation injury test models. One group was the hemipelvic restricted group (1,3,5,7,9,11,13); the one was the unrestricted group (2,4,6,8,10,12,14). In both the groups, 3-4 steel K-wires with a diameter of 1 cm were inserted into the pelvis from the middle of the fifth lumbar vertebrae to the center of the sacrum, and then the pelvis was embedded with a fixator to provide the axial load.…”

Section: Experiments Methodsmentioning

confidence: 99%

“…Thus, the injury mechanism and classification of APC type II need further refinement. There have been some biomechanical articles about APC pelvic fracture treatment [7,8]; however, there are few about ligamentous injury in APC pelvic fracture. Toward this end, we biomechanically modeled the pelvic external rotation injury (APC type II pelvis fracture) to explore pelvic ligamentous injury and the separation distance of the pubic symphysis and sacroiliac joint when anterior sacroiliac ligament (ASL) ruptured.…”

Section: Introductionmentioning

confidence: 99%

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A biomechanics study on ligamentous injury in anterior-posterior compression type II pelvic injury

et al. 2021

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Background Anterior-posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury. Method Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments. Result When ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05). Conclusion Pelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.

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Section: Discussionmentioning

confidence: 99%

Section: Experiments Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A biomechanics study on ligamentous injury in anterior-posterior compression type II pelvic injury

et al. 2021

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“…simulierten APC-II-Verletzungen in einer Kadaverstudie und konnten keine Unterschiede zwischen der Gruppe mit Symphysenplatte und der Gruppe mit Symphysenplatte und SI-Schraube nachweisen. Da insgesamt nur 7 Becken getestet wurden, sind sicherlich noch weitere Studien erforderlich, um diese Feststellung abschließend zu verifizieren [ 16 ]. Eine Umfrage aus dem Jahr 2017 zur Versorgung von APC-II-Verletzungen ergab, dass die Verwendung einer Symphysenplatte und einer SI-Schraube die gegenwärtig populärste Technik im Vereinigten Königreich ist [ 17 ].…”

Section: Diskussionunclassified

Ergebnisse nach Plattenstabilisierung der Symphysensprengung

et al. 2020

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“…31,32 Pelvic hardware loosening or failure is not uncommon but does not always correlate with loss of reduction or poor outcomes. 18,33,34 Pelvic ring fixation typically involves inserting implants that span the sacroiliac joints or the pubic symphysis. When patients resume ambulation, these joints move, creating stress across the implants.…”

Section: Complicationsmentioning

confidence: 99%

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Sanal¹,

Boulton

Neyisci³

et al. 2019

Semin Musculoskelet Radiol

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Good outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical reduction and rigid stability of articular fractures, and early postoperative mobilization. Multiple surgical approaches, reduction aids, and orthopaedic implants are available to stabilize these fractures. Despite best practices, complications including hardware failure, nonunions, malunions, and infections occur. This article discusses common fracture classification systems, implants, and imaging findings associated with unwanted complications in fractures of the pelvis, acetabulum, and femur.

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Does Posterior Fixation of Partially Unstable Open-Book Pelvic Ring Injuries Decrease Symphyseal Plate Failure? A Biomechanical Study

Abstract: Adding an iliosacral screw to the symphyseal plate fixation does not provide improved biomechanical outcome in classically described APC-2 injuries. Clinically, stress examination may be useful to determine the need for supplemental posterior fixation in APC-2 injuries.

Cited by 19 publications

References 23 publications

A biomechanics study on ligamentous injury in anterior-posterior compression type II pelvic injury

A biomechanics study on ligamentous injury in anterior-posterior compression type II pelvic injury

Ergebnisse nach Plattenstabilisierung der Symphysensprengung

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

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