Stability evaluation of anterior external fixation in patient with unstable pelvic ring fracture: a finite element analysis

Li, Lan; Lu, Jingwei; Lijun, Yang; Zhang, Kaijia; Jin, Jing; Sun, Guoqiang; Wang, Xingsong; Jiang, Qing

doi:10.21037/atm.2019.05.65

Cited by 10 publications

(12 citation statements)

References 20 publications

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“…Lateral stress may lead to internal fixation failure following fracture surgery; hence, it is best to avoid lateral lying after surgery. In addition, Lan Li et al analyzed the mechanical environment at 30°, 60°, and 90° in semi-recumbency after pelvic fracture surgery, and the results showed that the fracture displacement of patients seated at 90° was small and that there was no substantial mechanical concentration [ 12 ]. Therefore, we expect that patients with Tile B2 pelvic fracture can perform standing and sitting activities until the fracture heals within 3 months of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In the simulated standing position, the model constrained six degrees of freedom of the two-sided acetabulum and applied a vertical downward load of 600 N to the upper surface of the sacrum to simulate the upper body weight ( Figure 2 A). In the simulated standing and sitting position, the model constrained six degrees of freedom of two-sided ischial tuberosity and applied a vertical downward load of 600 N to the upper surface of the sacrum ( Figure 2 B) [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

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Finite Element Analysis of Channel Screw and Conventional Plate Technique in Tile B2 Pelvic Fracture

Ren

Zhang

et al. 2023

JPM

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Objective: This study aims to analyze the biomechanical characteristics of tile B2 pelvic fractures using finite element analysis when the superior ramus of the pubis was fixed by a plate or hollow screws in standing and sitting positions, respectively. Methods: A three-dimensional digital model of the tile B2 pelvic fracture was obtained by CT scanning the patient. The main ligament structure was then reconstructed based on the anatomical characteristics to create a finite element model of the tile B2 pelvic fracture. The posterior pelvic ring was fixed by sacroiliac joint screws, while the anterior ring injury of the superior ramus of the pubis was fixed by plates and hollow compression screws, respectively. The degrees of freedom of the bilateral acetabulum or two sides of the ischial tuberosity were constrained in the two models. A vertical load of 600 N was applied to the upper surface of the sacrum to measure the displacement and stress distribution of the pelvis in the standing and sitting positions. Results: The displacement distribution of both the healthy and the affected side of the pelvis was relatively uniform in both the plate group and the hollow screw group according to the finite element simulation results. The maximum displacement value in the sitting position was greater than the standing position, and the maximum displacement value of the hollow screw fixation was greater than that of the plate fixation. In the four groups of fixation models, the maximum displacement value of the pelvis in the hollow screw sitting position group was 1616.80 × 10−3 mm, which was greater than that of the other three groups, and in this group the total displacement value of the hollow screw in the anterior ring was 556.31 × 10−3 mm. The stress distribution of the pelvis in the various models was similar in the four groups of models, in which the maximum stress of the pelvis in the hollow screw sitting position group was the largest, which was 201.33 MPa, while the maximum stress in the standing position was 149.85 MPa greater than that in the sitting position of the hollow screw fixation. Conclusion: The anterior ring of patients with Tile B2 pelvic fractures fixed with hollow screws or plates in both standing and sitting positions can achieve satisfactory biomechanical results with significant safety margins for plates and screws.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Finite Element Analysis of Channel Screw and Conventional Plate Technique in Tile B2 Pelvic Fracture

Ren

Zhang

et al. 2023

JPM

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“…It is also reported in a large number of patients with multiple trauma (1). It is due to high-energy trauma, which is associated with damage to other organs, like chest and abdomen (2).…”

Section: Introductionmentioning

confidence: 97%

Pre-peritoneal Pelvic Pack with External Fixator versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; a Historical Cohort Study

Khoshmohabat

Paydar

Agah

2020

Preprint

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BackgroundPelvic fracture is one of the most common cause of death in traumatic patients. This study was designed to compare the outcome, morbidity and complications of treatment with pre-peritoneal pelvic pack with external fixator against pelvic pack alone in traumatic pelvic fracture and unstable hemodynamic patients.MethodsIn a retrospective case control study, patients with pelvic fracture and unstable hemodynamic state who referred to emergency and surgery department from August 2018 to August 2019 were enrolled by census manner. In the control group, 25 patients treated just by a pre-peritoneal pack (PPP group), while in the case group, pre-peritoneal pack and external fixator was done as the procedure to control bleeding (PPP Plus fixator group) in 22 individuals. Two groups were compared for presence of thromboembolism, hospital stay, infection, BUN, creatinine, rate of blood transfusion and mortality. ResultsMean age of participants were 34.48 ± 13.79 in pelvic pack group, while it was 32.36±16.29 in PPP plus external fixator ones. The mean Injury Severity Score (ISS) was 23.12±9.85 in Pelvic Pack group, and 19.22±8.09 in PPP plus external fixator group. Acute kidney injury was reported in 6 (24%) individuals of PPP group, while its rate in PPP plus fixator group was 40.9%. Mortality rate was reported 32% and 4.5% in control and case groups, respectively. There was a significant difference between groups (p=0.017, LR=6.42). VTE was reported 12% and 4.5% in PPP group and PPP plus fixator ones, respectively.ConclusionIt was concluded that using external fixator with PPP can be a useful method for treatment of pelvic fracture that is unstable in hemodynamic situation. It is recommended to use biomarkers like lactate or others to determine the situation of patients as precise as possible.

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“…Unstable posterior pelvic ring injuries (UPPRI) usually result from violent high-impact injuries (1)(2)(3). They are associated with high morbidity and mortality due to iatrogenic injury to anatomically contiguous structures and the prolonged patient immobilization that is often required in the event of complications (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, Original Article good treatment efficacy is a key surgical imperative that can help minimize complications and the duration of immobilization. Conservative treatment outcomes have been largely disappointing1, and are often associated with long-term sequelae such as chronic pain and an inability to walk normally (2,3).…”

Section: Introductionmentioning

confidence: 99%

An experimental study on the safe placement of sacroiliac screws using a 3D printing navigation module

Chen¹,

Zheng²,

Zhang³

et al. 2020

Ann Transl Med

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Background: In this experimental study, we evaluated the use of digital 3D navigation printing in minimizing complications arising from sacroiliac screw misplacement.Methods: A total of 13 adult pelvic specimens were studied using 3D navigation printing. Mimics software was used for preoperative planning and for obtaining sacrum median sagittal resection and long axis resection of the S1 pedicle center by 3D segmentation. The ideal screw path had its origin at the post-median part of the auricular surface of the sacroiliac joint, the midpoint at the mid-position of the lateral recess and outlet of the anterior sacral foramina; and the endpoint at the S1 sagittal resection. A sacroiliac screw fixed the pelvic specimens with the assistance of the navigation module. The distance between the start point (ilium surface) and endpoint (sacral median sagittal resection) of the screw path was measured after the pre-and postoperative 3D pelvis module was 3D-registered according to the standard precision range. The origin/endpoint qualified rates of the postoperative (n/26) and preoperative (26/26) screw paths were analyzed by the chi-square test.Results: No screw misplacement occurred in the screw paths of any of the 13 pelvic specimens. The mean distance between the preoperative and postoperative origin of the screw path was 1.5415±0.6806 mm, and the mean distance between the preoperative and postoperative endpoint was 2.2809±0.4855 mm. The qualified rate of origin was 23/26 when the precision grade was 2.4 mm (P>0.05, χ 2 =1.41), while the qualified rate of endpoint was 21/26 when the precision grade was 2.7 mm (P>0.05, χ 2 =3.54). Conclusions:In this experimental study, using a 3D printing navigation module helped attain an accurate and safe sacroiliac screw implantation.

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Stability evaluation of anterior external fixation in patient with unstable pelvic ring fracture: a finite element analysis

Cited by 10 publications

References 20 publications

Finite Element Analysis of Channel Screw and Conventional Plate Technique in Tile B2 Pelvic Fracture

Finite Element Analysis of Channel Screw and Conventional Plate Technique in Tile B2 Pelvic Fracture

Pre-peritoneal Pelvic Pack with External Fixator versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; a Historical Cohort Study

An experimental study on the safe placement of sacroiliac screws using a 3D printing navigation module

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