Percutaneous iliosacral screw fixation in unstable pelvic fractures

Bousbaä, Hicham; Ouahidi, Mohammed; Louaste, J.; Bennani, M.A.; Cherrad, Tawfiq; Jezzari, Hassan; Kasmaoui, E.H.; Rachid, K.; Amhajji, Larbi

doi:10.11604/pamj.2017.27.244.11506

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…Various internal implants have been used to control these injuries, including iliosacral screws (ISS), tension band plates (TBP), and transiliac sacral bars. ISS has become a commonly used technology in the treatment of pelvic posterior ring disruption. However, the ISS technique requires great surgical skill and continuous fluoroscopic guidance for appropriate screw insertion, and the risk of neurovascular injuries has been demonstrated to be higher than that for other techniques.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Wang

et al. 2019

Orthopaedic Surgery

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Objective To compare the biomechanical stability and compatibility of two iliosacral screws (ISS), a tension band plate (TBP), and a minimally invasive adjustable plate (MIAP) for treating Tile C pelvic fractures. Methods Three groups of finite element models of the intact pelvis, including the main ligament and the proximal one‐third of both femurs, were developed to simulate vertical sacral fractures and treated with the three abovementioned internal fixation techniques. A 500 N vertical load, a 500 N vertical load plus a 10 Nm moment of forward sagittal direction, and 500 N vertical load plus a 10 Nm moment of right lateral direction were applied to the sacrum to simulate standing status, bending status, and flexion status, respectively. The maximum displacement value, the stress value, and the stress value of the fracture interface were compared among the three internal fixation techniques. Results The results showed that all three internal fixation techniques effectively restored the biomechanical transmission of the injured pelvis. The stress on the implants in the TBP model was 167.47% and 53.41% higher than that in the ISS model and the MIAP model, respectively, and the stress shielding phenomenon of the TBP model was more obvious than in the other two models. Meanwhile, the stress between the fracture interfaces in the TBP fixation models was apparently higher than that in the other two models. However, the vertical displacement of the MIAP model was not significantly different from that in the ISS and TBP model; therefore, strong fixation could be obtained in all three models. Conclusion Based on our results, we believe that the stability of Tile C pelvic fracture fixed with MIAP was similar to that of fractures fixed with ISS and TBP, but the stress shielding phenomenon and safety of implants in the TBP models were inferior to those in the MIAP and ISS fixation models. Meanwhile, MIAP and ISS fixation were more helpful to the healing processing than was TBP fixation, especially at the fracture interface of the second and third vertebral body levels.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Wang

et al. 2019

Orthopaedic Surgery

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“…The sacroiliac joint, as a junction of the body and lower limb, plays a key role in maintaining the function of pelvis [2], thus the treatment after trauma is also important. Internal fixation is the main treatment for sacroiliac joint complex injury (SJI) [3], and sacroiliac screw fixation is the widely accepted one [4,5]. However, because of the anatomic feature, there are Wu Zhou and Tian Xia contributed to the work equally and should be regarded as co-first authors.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of sacroiliac screw placement guided by 3D-printed template technology and X-ray fluoroscopy

Zhou

Tian

Liu

et al. 2019

Arch Orthop Trauma Surg

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Objective To compare the clinical effect of 3D-printed template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screws placement. Design Institutional review board-approved retrospective analysis. Patients The clinical data of 31 cases of sacroiliac complex injury between January 2015 and December 2016 were analyzed. There were 16 patients, males 11 and females 5, who underwent surgery assisted by 3D-printed template in template group, and that of contemporaneous 15 patients, males 11 and females 4, who underwent traditional surgery were gathered as fluoroscopy group. All those patients were followed up for more than 6 months. Main outcome measures The operation time and X-ray fluoroscopy times for each screw placement, and the Matta and Majeed score were analyzed and the difference between the two group was tested. Results All cases were followed up for 6-20 months, average 11.4 ± 0.6 months. In template group, 19 screws were implanted. Each screw spent 25-38 min, average 27.2 ± 5.3 min, and need 2-5 times fluoroscopy, average 2.7 ± 0.5. The fracture reduction quality was evaluated by Matta score scale: excellent 10, well 4, fair 2, good rate 87.5%; and pelvic function were evaluated by Majeed score scale: excellent 11, well 3, fair 2, and good rate 87.5%. In fluoroscopy group, 17 screws were implanted. Each screw spent 45-70 min, average 60.3 ± 5.8 min, and needs 11-23 times fluoroscopy, average 15.4 ± 3.5. The fracture reduction quality was evaluated by Matta score scale: excellent 7, well 6, fair 2, and good rate 86.7%; and pelvic function was evaluated by Majeed score scale: excellent 6, well 6, fair 3, and good rate 80.0%. The difference in operation time, X-ray fluoroscopy times between template group and fluoroscopy group had statistical significance. But the Matta and Majeed score had no difference between two groups. Conclusion Compared with traditional surgery, 3D-printed template technology-assisted surgery for sacroiliac screws placement in sacroiliac complex injury patients possesses advantage such as shortened operation time and reduced X-ray exposure times. This technology improves the safety profile of this operation and should be further studied in future clinical applications.

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“…Currently, there are several internal fixation techniques for SJD, including percutaneous iliosacral (IS) screw, anterior plate, posterior transiliac plating, minimally invasive adjustable plate (MIAP), and so on [ 3 – 5 ]. These fixations have several advantages and disadvantages respectively, and none is proved to be the strongest fixation in the experiments and clinics.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical study of three kinds of internal fixation for the treatment of sacroiliac joint disruption using biomechanical test and finite element analysis

Ren

Cui

et al. 2018

J Orthop Surg Res

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BackgroundTo compare the stability of sacroiliac joint disruption fixed with three kinds of internal fixation using both biomechanical test and finite element analysis.MethodsFive embalmed specimens of an adult were used. The symphysis pubis rupture and left sacroiliac joint disruption were created. The symphysis pubis was stabilized with a five-hole plate. The sacroiliac joint disruption was fixed with three kinds of internal fixation in a randomized design. Displacements of the whole specimen and shifts in the gap were recorded. Three-dimensional finite element models of the pelvis, the pelvis with symphysis pubis rupture and left sacroiliac joint disruption, and three kinds of internal fixation techniques were created and analyzed.ResultsUnder the vertical load, the displacements and shifts in the gap of the pelvis fixed with minimally invasive adjustable plate (MIAP) combined with one iliosacral (IS) screw were the smallest, and the average displacements of the pelvis fixed with an anterior plate were the largest one. The differences among them were significant. In finite element analysis and MIAP combined with one IS screw fixation showed relatively best fixation stability and lowest risks of implant failure than two IS screws fixation and anterior plate fixation.ConclusionThe stability of sacroiliac joint disruption fixed with MIAP combined with one IS screw is better than that fixed with two IS screws and anterior plate under vertical load.

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Percutaneous iliosacral screw fixation in unstable pelvic fractures

Cited by 13 publications

References 23 publications

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Comparative study of sacroiliac screw placement guided by 3D-printed template technology and X-ray fluoroscopy

Biomechanical study of three kinds of internal fixation for the treatment of sacroiliac joint disruption using biomechanical test and finite element analysis

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