Locked Versus Standard Unlocked Plating of the Pubic Symphysis

Grimshaw, Charles S; Bledsoe, J. Gary; Moed, Berton R.

doi:10.1097/bot.0b013e31822c83bd

Cited by 35 publications

(13 citation statements)

References 17 publications

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“…5). These findings correspond with the current literature identifying symphyseal plating as an osteosynthesis method with sufficient biomechanical stability based on the fixation of the symphyseal joint [27,28].…”

Section: Discussionsupporting

confidence: 90%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Kußmaul

Schwaabe

Kistler³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge™) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. Materials and methods Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge™ in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. Results Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge™ techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). Conclusions Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge™ as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior.

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Section: Discussionsupporting

confidence: 90%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Kußmaul

Schwaabe

Kistler³

et al. 2021

Arch Orthop Trauma Surg

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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%

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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“…Therefore, we stimulated and modi ed two different APC injury models that 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 fth lumbar vertebrae to the center of the sacrum, and then the pelvis was embedded with a xator to provide the axial load.…”

Section: Experiments Methodsmentioning

confidence: 99%

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

Kong

Chu

Zhou

et al. 2020

Preprint

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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 mm 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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Locked Versus Standard Unlocked Plating of the Pubic Symphysis

Cited by 35 publications

References 17 publications

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

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

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