Percutaneous stabilization of the anterior pelvic ring in osteoporotic fractures

Wilke, Joachim; Pennig, D.

doi:10.1007/s00113-019-0659-z

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Currently, open reduction and internal fixation with a multi-hole plate has largely been accepted to be the gold standard [6], inhibiting mobility of the symphysis by consequently maintaining diastatic reduction [7].…”

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confidence: 99%

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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confidence: 99%

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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“…Iatrogenic injuries to the inguinal canal and its structures can result in remaining pain symptoms, and injuries to the corona mortis are known for devastating hemorrhages [ 24 ]. Since the symphysis is considered a synarthrosis with a physiological movement of up to 2 mm, a rigid plate fixation, considered as current gold standard treatment, can potentially result in implant failure and revision surgeries [ 14 , 23 , 25 – 27 ]. It was already proven in the literature that osteosyntheses of the anterior pelvic ring are known for a high prevalence of anterior plate failures [ 1 , 11 – 13 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aim of this biomechanical study was to evaluate an alternative semi-rigid fixation technique for treatment of anterior pelvic ring injuries versus the current gold standards of plate osteosynthesis [ 1 , 14 ]. This technique was designed to provide a decrease in the rates of failure and complications, and to avoid or simplify secondary operations for implant removal (IR) within the spectrum of minimally invasive pelvic surgery.…”

Section: Introductionmentioning

confidence: 99%

Substitutional semi-rigid osteosynthesis technique for treatment of unstable pubic symphysis injuries: a biomechanical study

Berk,

Zderic,

Varga

et al. 2023

Eur J Trauma Emerg Surg

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Background/Purpose The surgical fixation of a symphyseal diastasis in partially or fully unstable pelvic ring injuries is an important element when stabilizing the anterior pelvic ring. Currently, open reduction and internal fixation (ORIF) by means of plating represents the gold standard treatment. Advances in percutaneous fixation techniques have shown improvements in blood loss, surgery time, and scar length. Therefore, this approach should also be adopted for treatment of symphyseal injuries. The technique could be important since failure rates, following ORIF at the symphysis, remain unacceptably high. The aim of this biomechanical study was to assess a semi-rigid fixation technique for treatment of such anterior pelvic ring injuries versus current gold standards of plate osteosynthesis. Methods An anterior pelvic ring injury type III APC according to the Young and Burgess classification was simulated in eighteen composite pelvises, assigned to three groups (n = 6) for fixation with either a single plate, two orthogonally positioned plates, or the semi-rigid technique using an endobutton suture implant. Biomechanical testing was performed in a simulated upright standing position under progressively increasing cyclic loading at 2 Hz until failure or over 150,000 cycles. Relative movements between the bone segments were captured by motion tracking. Results Initial quasi-static and dynamic stiffness, as well as dynamic stiffness after 100,000 cycles, was not significantly different among the fixation techniques (p ≥ 0.054).). The outcome measures for total displacement after 20,000, 40,000, 60,000, 80,000, and 100,000 cycles were associated with significantly higher values for the suture technique versus double plating (p = 0.025), without further significant differences among the techniques (p ≥ 0.349). Number of cycles to failure and load at failure were highest for double plating (150,000 ± 0/100.0 ± 0.0 N), followed by single plating (132,282 ± 20,465/91.1 ± 10.2 N), and the suture technique (116,088 ± 12,169/83.0 ± 6.1 N), with significantly lower values in the latter compared to the former (p = 0.002) and no further significant differences among the techniques (p ≥ 0.329). Conclusion From a biomechanical perspective, the semi-rigid technique for fixation of unstable pubic symphysis injuries demonstrated promising results with moderate to inferior behaviour compared to standard plating techniques regarding stiffness, cycles to failure and load at failure. This knowledge could lay the foundation for realization of further studies with larger sample sizes, focusing on the stabilization of the anterior pelvic ring.

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Tape suture constructs for instabilities of the pubic symphysis: is the idea of motion preservation a suitable treatment option? A cadaver study

Kußmaul¹,

Schwaabe²,

Kistler³

et al. 2022

Arch Orthop Trauma Surg

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Introduction Current gold standard for the treatment of symphyseal disruptions includes anterior plating, almost entirely prohibiting symphyseal mobility and resulting in an iatrogenic arthrodesis followed by high rates of implant failure. Minimally invasive tape suture constructs have been found to maintain the micro mobility of ligamentous injuries, yet still providing sufficient biomechanical stability. Recently, this technique has been primarily investigated for symphyseal disruptions on synthetic pelvic models. Therefore, the aim of this study was to examine the feasibility of this novel flexible osteosynthesis on cadaveric pelvic models based on the following hypothesis: tape suture constructs ensure sufficient biomechanical stability without inhibiting micro mobility of the pubic symphysis for the treatment of symphyseal disruptions and maintain stability during long-term loading. Materials and methods 9 cadaveric anterior pelvic rings were used in this study and a symphyseal disruption was created in every specimen. The specimens were then exposed to short- and long-term vertical and horizontal cyclic loading after treatment with a tape suture construct in criss-cross technique. The mean maximum displacement (mm) during cyclic loading and the corresponding stiffness (N/mm) were measured and compared. Results Regarding both displacement (mm) and corresponding stiffness (N/mm), the tape sutures displayed a significant difference between short- and long-term loading for cranial and caudal vertical loading (p < 0.01) but differences remained non-significant for horizontal loading (p > 0.05). No tape suture suffered from implant failure during long-term loading. Conclusions The tape suture construct displayed sufficient biomechanical stability without exceeding the physiological mobility of 2 mm of the pubic symphysis; however, also maintained the desired micro mobility of the affected joint necessary to prevent an iatrogenic arthrodesis. Further, all tape sutures maintained stability throughout long-term loading.

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Percutaneous stabilization of the anterior pelvic ring in osteoporotic fractures

Cited by 3 publications

References 20 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

Substitutional semi-rigid osteosynthesis technique for treatment of unstable pubic symphysis injuries: a biomechanical study

Tape suture constructs for instabilities of the pubic symphysis: is the idea of motion preservation a suitable treatment option? A cadaver study

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