Trans-obturator cable fixation of open book pelvic injuries

Abstract

Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

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

“…Furthermore, the cable fixation as described by the authors Fig. 4 Illustration of the distribution of tension of the tapes before (1) and after (2) initial loading poses the challenge of a vertical dislocation due to the exposure to shear forces [11]. This problem can be avoided by the use of anchor systems, ensuring sufficient stability in all planes as demonstrated by our results.…”

“…Besides, Jordan et al investigated the implantation of a trans-obturator fixation for symphyseal disruption and reported this cable fixation as a promising alternative to anterior plating based on comparable biomechanical properties [11]. Yet, this technique requires a more extensive surgical approach compared to the tension bands tested in this study and again involves a posterior looping of the cables around the pubic symphysis including the obturator foramen [11], posing a risk for the obturator vessels and nerves which can be avoided by the anterior mounting of the tape suture. Furthermore, the cable fixation as described by the authors Fig.…”

“…Considering the second research question of this study, none of the specimens experienced implant loosening or failure after exposure to long-term loading. While long-term loading and concomitant cutting of the cables into the bone with consecutive impairment of stability has been found to be a challenging complication in previous investigated cerclage and wiring techniques [11,20], the here implanted anchor systems enforce long-term biomechanical stability due to their entire placement in the pubic bone and their function as a connection link between the tape and the pubic bone.…”

“…Consequently, several approaches have been made to address this issue, including wires, cable cerclages and endobuttons, stressing the need for new technologies, especially given the fact of a pending enforcement of such a promising technique [11,12].…”

Comparative Finite Element Analysis of Fixation Techniques for APC II Open-Book Injuries of the Pelvis

“…To preserve physiological joint mobility, Labitzke and Witzel suggested a dynamic fixation using a sleeve-cable tensioning [20]. In a recent in vitro study, Jordan et al underlined the potential for trans-obturator cable fixation in open-book fractures [21]. In a similar fashion, minimally invasive tape suture osteosynthesis of the pubic symphysis was suggested [22].…”