Triangular Osteosynthesis and Iliosacral Screw Fixation for Unstable Sacral Fractures: A Cadaveric and Biomechanical Evaluation Under Cyclic Loads

Schildhauer, Thomas A.; Ledoux, William R.; Chapman, Jens R.; Henley, M. Bradford; Tencer, Allan F.; Routt, Milton L

doi:10.1097/00005131-200301000-00004

Cited by 245 publications

(163 citation statements)

References 44 publications

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“…PTO combines a vertical (lumbopelvic) and horizontal (iliosacral) fixation, providing a good degree of protection against cranial migration of the injuried half of the pelvic ring [15] by transferring vertical loads from the lower lumbar spine to the ilium. The sacral fracture result partially protected from these loads and the horizontal component stabilizes the fracture in the horizontal plane, so resisting certain counterforces, such as the internal rotation observed in a biomechanical study [17]. The PTO for unstable sacral fractures provides greater immediate post-operative stability compared with iliosacral screw fixation, as shown in an experimental study [17].…”

Section: Discussionmentioning

confidence: 95%

“…The sacral fracture result partially protected from these loads and the horizontal component stabilizes the fracture in the horizontal plane, so resisting certain counterforces, such as the internal rotation observed in a biomechanical study [17]. The PTO for unstable sacral fractures provides greater immediate post-operative stability compared with iliosacral screw fixation, as shown in an experimental study [17].…”

Section: Discussionmentioning

confidence: 95%

“…In fact, unprotected weight-bearing in this type of fracture has been associated with post-operative complications, such as loss of reduction and secondary neural impairment [17]. Nevertheless, it can be difficult to obtain a stable fixation of the sacrum itself, particularly because the lumbosacral junction must resist large forces as well as allowing motion [10].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Modified triangular posterior osteosynthesis of unstable sacrum fracture

Mouhsine¹,

Wettstein²,

Schizas³

et al. 2005

Eur Spine J

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Modified triangular posterior osteosynthesis of unstable sacrum fracture

Mouhsine¹,

Wettstein²,

Schizas³

et al. 2005

Eur Spine J

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“…However, Schildhauer et al [12] pointed out that this kind fixation cannot guarantee rotational stability because it addresses vertical forces only, whereas rotational stability cannot be achieved by the vertical twopoint fixation. To solve this problem, triangular osteosynthesis for unstable sacral fractures had been recently introduced [12][13][14][15][16]. This fixation combines a transverse fixation with a lumbopelvic distraction osteosynthesis, providing clinically and biomechanically sufficient multiplanar stability [16,18].…”

Section: Discussionmentioning

confidence: 99%

“…However, none of these fixation instruments can resist vertical shear forces, provide unrestricted weightbearing, and secure mobilization after operation. Recent studies demonstrated that triangular osteosynthesis is a new option for the treatment of type C pelvic fracture following unstable sacral fractures [12][13][14][15][16]. This fixation combines a lumbopelvic distraction osteosynthesis and a transverse fixation, which provides multiplanar stability.…”

Section: Introductionmentioning

confidence: 99%

Application triangular osteosynthesis for vertical unstable sacral fractures

Pei

Wang

et al. 2012

Eur Spine J

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Purpose The aim of this study was to explore the operative technique and effectiveness of triangular osteosynthesis for vertically unstable sacral fractures. Methods From January 2009 to December 2010, 25 vertical unstable sacral fractures in 22 patients were treated with triangular osteosynthesis using the combination of universal spine system and iliosacral screw in our institution. Patients were followed up prospectively with routine post-operation visits for clinical and radiographic examination. The reduction quality was evaluated according to Matta criterion. Clinical function outcome, and nerve function outcome was evaluated by Majeed and Gibbons criterion. Results All patients were followed up for an average of 14 months (range 8-26 months). Local infection was seen in two patients, and both were healed with debridement and antibiotics. Patients experienced early weight-bearing ability, no fracture reduction loss, and hardware loosening, while all fractures appeared as bone union at the final follow-up. According to Matta criterion for fracture reduction, the results were excellent in 18 sides, good in 6 sides, and fair in 1 side. According to Majeed functional scoring at last follow-up, the results were excellent in 13 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Neurologic impairment was noted in 13 patients preoperative, six patients achieved complete recovery, six patients achieved partial improvement, one patient did not have any improvement at the last follow-up.Conclusion Triangular osteosynthesis is a relatively new fixation for vertical unstable sacral fractures, the fixation is rigid, permits early full weight-bearing, and nerve decompression can be performed, which facilitates function recovery.

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Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model

et al. 2016

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Operative treatment of sacral insufficiency fractures is frequently being complicated by osteopenic bone properties. Cement augmentation of implanted sacroiliac screws may lead to superior construct stability and prevent mechanical complications. A novel hemi-pelvis test model with dissected symphysis was developed. Five fresh-frozen cadaveric pelvises were vertically osteotomized at the sacrum on both sides and fixed with sacroiliac screws in both corridors of the first sacral vertebral body. One side was randomly augmented with bone cement. Cyclic testing consisting of torsional loading (±2.5 Nm) combined with progressively increasing axial loading (+50 N compression, -10 N traction, ±0,01 N/cycle) was performed until failure; simulated physiological loads derived from inverse dynamic calculations. The fixation was analyzed fluoroscopically quantifying screw migrations and assessing failure mechanisms. Failure modes were cut-out, pull-out, screw-out, and washer penetration. Motion at fracture site was analyzed via optical motion tracking. Unscrewing was provoked four times with non-augmented and twice with augmented screws. When focusing on the sacral region only, cement augmentation significantly improved screw fixation in terms of increased number of cycles to failure (p = 0.043). However, when considering overall construct stability, there was no significant difference between augmented and non-augmented state due to washer penetration at the iliac bone. The generated hemi-pelvis model was found to be valid due to the reproduction of the clinically observed failure mode (unscrewing). Unscrewing was not fully prevented by cement augmentation. Augmentation effects stability at the screw tip, but particularly in porotic bone, failure may shift to the next weak point. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1485-1493, 2017.

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Triangular Osteosynthesis and Iliosacral Screw Fixation for Unstable Sacral Fractures: A Cadaveric and Biomechanical Evaluation Under Cyclic Loads

Cited by 245 publications

References 44 publications

Modified triangular posterior osteosynthesis of unstable sacrum fracture

Modified triangular posterior osteosynthesis of unstable sacrum fracture

Application triangular osteosynthesis for vertical unstable sacral fractures

Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model

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