Ligamentous influence in pelvic load distribution

Hammer, Niels; Steinke, Hanno; Lingslebe, Uwe; Bechmann, Ingo; Josten, Christoph; Slowik, Volker; Böhme, Jörg

doi:10.1016/j.spinee.2013.03.050

Cited by 75 publications

(100 citation statements)

References 61 publications

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“…However, the underlying data on which this classification is based remains obscure, especially since ligaments can only be visualized in standard X‐ray under exceptional circumstances, that is, partial ossification. The previous assumption that the sacrospinous and sacrotuberous ligaments are capable of stabilizing the pelvis horizontally and vertically can be confirmed on the basis of our simulation data shown here and elsewhere . However, the mechanisms of ligament disruption appear to be somehow different: after complete rupture of the pubic symphysis, the anterior sacroiliac ligaments are torn once the pubic symphysis is widened more than 22 mm on the average .…”

Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

“…Parts of the materials and methods concerning the construction of the pelvic ring finite elements (FE) model consisting of bones, cartilage, and ligaments will briefly be dealt with. For more details, please see Hammer et al 16 Model Construction of Bones, Ligaments, and Cartilage Geometries of both pelvic bones and the sacrum were based on computed tomography (Brilliance 64 CT, Philips Healthcare GmbH, Hamburg, Germany; slice thickness ¼ 1 mm, slice spacing 1 mm, 285 slices, resolution 512 Â 512 pixels) of a male pelvis, as proposed by Shim et al 18 The geometrical data were imported into Ansys Workbench 12.0 (Ansys, Inc., Canonsburg, PA). The FE model was created using tetrahedral elements for the bone structures.…”

Section: Methodsmentioning

confidence: 99%

“…[12][13][14][15] In a previously developed computer model of the pelvic belt, we could prove the function of the anterior sacroiliac, sacrospinous, and of the sacrotuberous ligaments in maintaining pelvic stability. 16,17 However, the mechanisms related to APC and the influence of the pelvic ligaments in resisting the injury is mostly unclear. 8 The aim of our present study was therefore to use the computer model with representative material properties of the ligaments for determining the extent of ligament strain and injury related to 100 mm symphyseal widening, and to compare these data to existing clinical and experimental data.…”

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confidence: 99%

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The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Böhme

Lingslebe

Steinke

et al. 2014

Journal Orthopaedic Research

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Surgical stabilization of the pelvis following type II anteroposterior compression pelvic injuries (APCII) is based on the assumption that the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments disrupt simultaneously. Recent data on the ligaments contradict this concept. We aimed at determining the mechanisms of ligament failure in APCII computationally. In an individual osteoligamentous computer model of the pelvis, ligament load, and strain were observed for the two-leg stance, APCII with 100-mm symphyseal widening and for two-leg stance with APCII-related ligament failure, and validated with body donors. The anterior sacroiliac and sacrotuberous ligaments had the greatest load with 80% and 17% of the total load, respectively. APCII causes partial failure of the anterior sacroiliac ligament and the pelvis to become horizontally instable. The other ligaments remained intact. The sacrospinous ligament was negligibly loaded but stabilized the pelvis vertically. The interosseous sacroiliac and sacrotuberous ligaments are likely responsible for reducing the symphysis and might serve as an indicator of vertical stability. The sacrospinous ligament appears to be of minor significance in APCII but plays an important role in vertical stabilization. Further research is necessary to determine the influence of alterations in ligament and bone material properties. Keywords: anterior compression pelvic injury; finite element computer study; pelvic biomechanics; sacroiliac joint ligaments; pubic symphysis widening Anteroposterior compression pelvic injuries (APC) or "open book" injuries of the pelvis are most commonly the result of high velocity trauma related to motorcycle or motor vehicle accidents or falls from great heights. 1The Young-Burgess classification system of pelvic injury was developed to predict patient morbidity and mortality and to identify potential needs of non-surgical or operative treatment.1,2 APC are further classified depending on the estimated extent of injury, ranging from mechanically stable APCI via horizontally unstable APCII to completely unstable APCIII disruptions. While, there is a wide consensus that APCII and III should be stabilized surgically, 3,4 the extent of stabilization in all APC is still under discussion.5-7 As a commonly stated postulate, a pubic symphysis widening of more than 25 mm indicates instabilities of the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments 2 (APCII), and therefore requires surgical intervention. However, this value appears to be arbitrary and there is increasing biomechanical 8,9 and clinical evidence 10 that especially the sacrospinous and the sacrotuberous ligaments might not necessarily be injured in APCII and also that sacroiliac joint screws might not provide additional pelvic stability following these cases.11 Moreover, the function of the sacrospinous and sacrotuberous ligaments as pelvic stabilizers is questioned by several authors.12-15 In a previously developed computer model of the pelvic belt, we could prove th...

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Böhme

Lingslebe

Steinke

et al. 2014

Journal Orthopaedic Research

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“…Корж с соавт. [1] и N. Hammer [10] на математической модели было доказано, что при наклоне крестца и таза горизонтальная ось ротацион-ной подвижности (нутации) крестца будет смещаться на более высокой стороне кпереди и книзу, а на более низкой стороне -кзади, кверху и будет значительно возрастать сила трения между крестцовой и подвздош-ной частями сустава. Это будет вызывать увеличение объема нутации крестца на более высокой стороне и практически отсутствие нутации крестца на нижесто-ящей стороне.…”

Section: îáñóAeäåíèåunclassified

Особливості функціонування м’язів — глобальних стабілізаторів в осіб з асиметричним розташуванням таза та крижів у фронтальній площині Повідомлення 2. Дослідження активності m. gluteus medius, m. obliquus externus, m. biceps femoris, m. rectus femoris

Staude¹,

Kotulskyi²,

Дуплий³

et al. 2022

TRAUMA

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Актуальність. У роботі досліджені електроміографічні параметри м’язів m. erectorspinae, m. gluteusmedius, m. abdominis obliquus, m. bicepsfemoris, m. rectus femoris у волонтерів при виконанні двухопорного стояння, стояння на одній нозі і стояння на одній нозі з вантажем. Мета дослідження: вивчити зміну електроміографічних показників м’язів при різних кутах нахилу системи «крижі — таз» при виконанні тестів. Матеріали та методи. Було обстежено 36 волонтерів, яких розподілили на 5 груп за величиною і стороною нахилу таза та крижів. Вивчали такі параметри міограми: максимальну, середню та сумарну амплітуди й частоту. Результати. У результаті аналізу даних було визначено, що при двохопорному стоянні у волонтерів не було виявлено значимих відмінностей параметрів міограми. При одноопорному стоянні, особливо з вантажем, спостерігається значне збільшення всіх параметрів міограми на стороні опорної кінцівки. Підвищення кута нахилу таза і крижів викликає ще більше збільшення активності показників міограми, особливо при контралатеральному нахилі системи «крижі — таз». Висновки. Збільшення кута нахилу таза та крижів викликає підвищення всіх параметрів активності електроміограми m. gluteus medius на стороні нахилу при двохопорному стоянні. При одноопорному стоянні спостерігаються значні збільшення амплітудних параметрів електроміограми m. gluteus medius на стороні опорної кінцівки при всіх варіантах нахилу крижів і таза. При одноопорному стоянні з вантажем ця тенденція зберігається. При одноопорному стоянні активність m. abdominis obliquus externus підвищується з обох сторін.

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Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

et al. 2018

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The sacrospinous (SS) and sacrotuberous (ST) ligaments form a complex at the posterior pelvis, with an assumed role as functional stabilizers. Experimental and clinical research has yielded controversial results regarding their function, both proving and disproving their role as pelvic stabilizers. These findings have implications for strategies for treating pelvic injury and pain syndromes. The aim of the present simulation study was to assess the influence of altered ligament function on pelvis motion. A finite elements computer model was used. The two-leg stance was simulated, with the load of body weight applied via the fifth lumbar vertebra and both femora, allowing for nutation of the sacroiliac joint. The in-silico kinematics were validated with in-vitro experiments using the same scenario of load application following SS and ST transection in six human cadavers. Modeling of partial or complete ligament failure caused significant increases in pelvis motion. This effect was most pronounced if the SS and ST were affected with 164% and 182%, followed by the sacroiliac and iliolumbar ligaments with 123% and 147%, and the pubic ligaments with 113% and 119%, for partial and complete disruption, respectively. Simultaneous ligament transection multiplied the effects on pelvis motion by up to 490%. Unilateral ligament injury altered the motion at the pelvis contralaterally. The experiments presented here provide strong evidence for the stabilizing role of the SS and ST. A fortiori, the instability resulting from partial or complete SS and ST injury merits consideration in treatment strategies involving these ligaments as important stabilizers. Clin. Anat. 32:231-237, 2019.

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Ligamentous influence in pelvic load distribution

Cited by 75 publications

References 61 publications

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

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