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Tian D, Guo X, Liu N, Wang B, He H, Xiong M. A Modified Triangular Osteosynthesis Protocol for the Rod and Pedicle Screw Fixation of Vertical Unstable Sacral Fractures. Int J Spine Surg 2021; 15:485-493. [PMID: 33985998 DOI: 10.14444/8070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The stabilization of vertical unstable sacral fractures has been a complex problem that is a challenge to current standard approaches. Here, we attempted to evaluate a modified technique for sacral fractures. METHODS In the modified triangular osteosynthesis technique, we adopted a vertical and transverse fixation with a rod and pedicle screw system to reduce and fix sacral fractures in 28 subjects. The postsurgery effect of this technique was evaluated by physical examination and radiography. RESULTS In the postoperative day 1, the patients were able to move body position passively from the lateral side to supine and exercise their legs by themselves. After a follow up of 20 months, radiological evaluation showed that fracture fragment reduction was excellent in 18 (64%), good (displacement 5-10 mm) in 8 (29%), and fair (displacement 10-15 mm) in 2 (7%) patients. Three patients with a preoperative perineal neurological impairment had a complete recovery after surgical decompression. All patients had achieved bone union of fractures, and no loss of fracture reduction was detected. CONCLUSIONS The modified procedures offered an easier approach to fix vertical unstable sacral fractures, thereby achieving quicker and stable functionality. This suggests an alternative approach to manage unstable sacral fractures. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE The stabilization of vertical unstable sacral fractures has been a complex problem that is a challenge to current standard approaches. We attempted to introduce a modified technique for sacral fractures.
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Affiliation(s)
- Dawei Tian
- Department of Orthopedics, Hubei University of Medicine Dongfeng Hospital, Shiyan 442008, Hubei, China
| | - Xiaojun Guo
- Department of General Surgery, Hubei University of Medicine Dongfeng Hospital, Shiyan 442008, Hubei, China
| | - Na Liu
- Department of Information Management and Information System, Hubei University of Medicine, Shiyan 442008, Hubei, China
| | - Bo Wang
- Department of Spine Section, University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen 518003, Guangdong, China
| | - Hongsheng He
- Department of Orthopedics, Hubei University of Medicine Dongfeng Hospital, Shiyan 442008, Hubei, China
| | - Min Xiong
- Department of Orthopedics, Hubei University of Medicine Dongfeng Hospital, Shiyan 442008, Hubei, China
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Venayre B, Koyama Y, Kurosawa D, Hammer N, Lingslebe U, Murakami E, Ozawa H, Ohashi T. Quantitative evaluation of the sacroiliac joint fixation in stress reduction on both sacroiliac joint cartilage and ligaments: A finite element analysis. Clin Biomech (Bristol, Avon) 2021; 85:105350. [PMID: 33878625 DOI: 10.1016/j.clinbiomech.2021.105350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The sacroiliac joint fixation is the last resort for patients with prolonged and severe joint pain. Although the clinical results of anterior fixations are conclusive, there exist several inevitable drawbacks with the surgical method such as the difficulty performing the surgery due to the presence of many organs. The posterior fixation technique has thus been developed to overcome those inconveniences. This study aims to assess in silico the mechanical environment following posterior and anterior fixations, focusing on stresses in both the sacroiliac cartilage and dorsal ligamentous part, as well as loads experienced by the pelvic ligaments. METHODS Sacroiliac joint cartilage, dorsal ligamentous part stresses and pelvic ligaments loads were evaluated with three types of fixation models. A vertical load of 600 N was applied, equally distributed via both acetabula when standing and sitting. FINDINGS Results show that the anterior sacroiliac joint fixation reduced von Mises stresses in the cartilage and dorsal ligamentous part and decreased ligaments loads more extensively than the posterior fixation when compared to the untreated model as a reference. However, the posterior fixation still remains the desirable and preferential treatment. INTERPRETATION The anterior sacroiliac joint fixation showed better performances compared to the posterior one; however, the lower invasive aspect of the latter is a fundamental clinical advantage which also has the possibility to be improved by considering various screws and cages configurations. This study provides a beneficial suggestion to improve the current fixation technique.
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Affiliation(s)
- Brice Venayre
- Division of Human Mechanical Systems and Design, Graduate School of Engineering, Hokkaido University, Sapporo, Japan
| | - Yuichiro Koyama
- Division of Human Mechanical Systems and Design, Graduate School of Engineering, Hokkaido University, Sapporo, Japan
| | - Daisuke Kurosawa
- Department of Orthopaedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan
| | - Niels Hammer
- Department of Clinical and Macroscopic Anatomy, Medical University of Graz, Graz, Austria; Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Fraunhofer IWU, Dresden, Germany
| | | | - Eiichi Murakami
- Department of Orthopaedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan
| | - Toshiro Ohashi
- Division of Mechanical and Aerospace Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.
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Cross WW, Berven SH, Slater N, Lehrman JN, Newcomb AGUS, Kelly BP. In Vitro Biomechanical Evaluation of a Novel, Minimally Invasive, Sacroiliac Joint Fixation Device. Int J Spine Surg 2018; 12:587-594. [PMID: 30364882 DOI: 10.14444/5072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Sacroiliac (SI) joint pathology may result in low-back pain, which causes substantial disability. Treatment failure with operative management of SI pain may be related to incomplete fusion of the joint and to fixation failure. The objective of this study was to evaluate the initial biomechanical stability of SI joint fixation with a novel implantable device in an in vitro human cadaveric model. Methods The right and left sides of 3 cadaveric L4-pelvis specimens were tested (1) intact, (2) destabilized, and (3) instrumented with an implantable SI joint fixation device using a simulated single-stance load condition. Right-leg and left-leg stance data were grouped together for a sample size of 6, and angular range of motion (ROM) was determined during application of flexion-extension, lateral bending, and axial rotation bending moments to a limit of 7.5 Nm. Results Following intact testing, destabilization by severing the posterior SI joint capsule and ligaments and the pubic symphysis reliably produced a significantly destabilized joint with the mean angular ROM more than doubling in flexion-extension and lateral bending and more than tripling in axial rotation (P ≤ .003) compared to the intact condition. Instrumentation with the SI screw fixation device significantly reduced mean joint ROM compared to the destabilized condition in all 3 anatomic planes tested (P < .001). When compared to the intact condition, the SI-instrumented condition significantly reduced lateral bending (P = .01) and had a similar ROM in flexion-extension (P = .14) and axial rotation (P = .85). Conclusions Instrumentation with the SI screw fixation device significantly reduced mean joint ROM compared to the destabilized condition, with similar ROM in flexion-extension and axial rotation, and it significantly reduced ROM in lateral bending compared to that for the intact joint. The ROM values observed with the instrumented condition were comparable to levels of mobility considered favorable for spinal fusion.
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Affiliation(s)
- William W Cross
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sigurd H Berven
- Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, California
| | | | - Jennifer N Lehrman
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Anna G U S Newcomb
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brian P Kelly
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med 2017; 87:250-257. [PMID: 28618337 DOI: 10.1016/j.compbiomed.2017.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 11/23/2022]
Abstract
The pelvis is one of the most stressed areas of the human musculoskeletal system due to the transfer of truncal loads to the lower extremities. Sacroiliac joint injury may lead to abnormal joint mechanics and an unstable pelvis. Various fixation techniques have been evaluated and discussed. However, it may be difficult to investigate each technique due to variations in bone quality, bone anatomy, fracture pattern, and fixation location. Additionally, the finite element method is one useful technology that avoids these variations. Unfortunately, most previous studies neglected the effects of the lumbar spine and femurs when they investigated the biomechanics of pelvises. Thus, the aim of this study was to investigate the biomechanical performance of intact, injured, and treated pelvises using numerical and experimental approaches. Three-dimensional finite element models of the spine-pelvis-femur complex with and without muscles and ligaments were developed. The intact pelvis, the pelvis with sacroiliac joint injury, and three types of pelvic fixation techniques were analyzed. Concurrently, biomechanical tests were conducted to validate the numerical outcomes using artificial pelvises. Posterior iliosacral screw fixation showed relatively better fixation stability and lower risks of implant failure and pelvic breakage than sacral bar fixation and a locking compression plate fixation. The present study can help surgeons and engineers understand the biomechanics of intact, injured, and treated pelvises. Both the simulation technique and the experimental setup can be applied to investigate different pelvic injuries.
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Louer CR, Nassif NA, Brodt MD, Leib DJ, Silva MJ, McDonald DJ. Mechanical comparison of iliosacral reconstruction techniques after sarcoma resection. Clin Biomech (Bristol, Avon) 2016; 38:35-41. [PMID: 27564578 PMCID: PMC6097531 DOI: 10.1016/j.clinbiomech.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/08/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reconstruction of iliosacral defects following oncologic resection is a difficult clinical problem associated with a high incidence of failure. Technical approaches to this problem are heterogeneous and evidence supporting specific techniques is sparse. Maximizing construct stability may improve union rates and functional outcomes. The purpose of this study is to compare construct stiffness, load to failure, and mechanism of failure between two methods of iliosacral reconstruction in an ex-vivo model to determine if either is mechanically superior. METHODS Eight third-generation composite pelves reconstructed with a plate-and-screw technique were tested against seven pelves reconstructed with a minimal spinal instrumentation technique using axial loading in a double-leg stance model. FINDINGS The pelves from the plate group demonstrated higher stiffness in the direction of applied load (102.9 vs. 66.8N/mm; p=0.010) and endured a significantly larger maximum force (1416 vs. 1059N; p=0.015) than the rod group prior to failure. Subjectively, the rod-reconstructed pelves were noted to be rotationally unconstrained while pivoting around their single point-of fixation in each segment leading to earlier failure. INTERPRETATION Plate-reconstruction was mechanically superior to spinal instrumentation in the manner performed in this study. More than one point of fixation in each segment should be achieved to minimize the risk of rotational deformation.
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Affiliation(s)
- Craig R. Louer
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Nader A. Nassif
- Newport Orthopedic Institute, 22 Corporate Plaza Drive, Newport Beach, CA 92660, USA,Hoag Orthopedic Institute, 16250 Sand Canyon Ave, Irvine, CA 92618, USA
| | - Michael D. Brodt
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Daniel J. Leib
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Matthew J. Silva
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Douglas J. McDonald
- Washington University School of Medicine, Department of Orthopaedic Surgery Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110, USA
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Alvis-Miranda HR, Farid-Escorcia H, Alcalá-Cerra G, Castellar-Leones SM, Moscote-Salazar LR. Sacroiliac screw fixation: A mini review of surgical technique. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 5:110-3. [PMID: 25336831 PMCID: PMC4201009 DOI: 10.4103/0974-8237.142303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique.
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