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Regenbogen S, Barbari JE, Vetter SY, Franke J, Grützner PA, Swartman B. Feasibility and Safety of 3D-Navigated Trans-Sacral Bar Osteosynthesis for Fragility Fractures of the Sacrum: FIRST Clinical Experiences. J Clin Med 2024; 13:5244. [PMID: 39274457 PMCID: PMC11396487 DOI: 10.3390/jcm13175244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/16/2024] Open
Abstract
Background: There has been an increasing number of fragility fractures of the sacrum in the recent decade. With rates of up to 28%, the complication rates after surgical treatment are still at an unacceptably high level, and new treatment strategies are urgently needed. Therefore, the purpose of this study was to evaluate the potential of 3D-navigated trans-sacral bar osteosynthesis in the surgical treatment of fragility fractures of the sacrum. Methods: Retrospectively, from 2017 to 2023, all cases with confirmed fragility fractures of the sacrum in patients > 65 years of age that were surgically treated with navigated 3D-navigated trans-sacral bar osteosynthesis were included, and epidemiological data and the course of treatment analyzed in comparison to a matched control group. Results: Finally, 21 patients (18 women and 3 men) were included in this study. The average age of the patients was 82.6 (SD 6.3) in the intervention group and 79.4 (SD 6.7) in the control group. There were postoperatively detected complications in two cases (18%) in the intervention group and in four cases (40%, p = 0.362) in the control group. The postoperative in-hospital stay was 10 days (SD 3.8) vs. 11.4 days (SD 3.8) in the control. None of the patients in the intervention group and two in the control group needed revision surgery. Conclusions: Overall, 3D-navigated trans-sacral bar osteosynthesis seems to be a promising technique, enabling an accurate implant positioning while offering a low complication rate with an excellent short-term outcome in elderly patients with fragility fractures of the sacrum.
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Affiliation(s)
- Stephan Regenbogen
- BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Jan El Barbari
- BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | | | | | - Benedict Swartman
- BG Klinik Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
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Klingebiel FKL, Kalbas Y, Klee O, Long A, Teuben M, Teuber H, Halvachizadeh S, Berk T, Neuhaus V, Pape HC, Pfeifer R. Efficacy and outcomes of rescue screws in unstable pelvic ring injuries - A retrospective matched cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02649-x. [PMID: 39190065 DOI: 10.1007/s00068-024-02649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE The emergency treatment of unstable pelvic ring injuries is still a challenge and requires surgical and anesthesiological resuscitation. Emergency fixation of the unstable pelvic ring with percutaneous sacroiliac (SI) screws, also known as "Rescue Screws", is an established treatment method. The aim of our study was to compare the outcome and complication rates of "Rescue Screws" with elective SI-screw fixations. METHODS A 1:1 ratio nearest-neighbor matched, retrospective cohort study of trauma patients with acute pelvic ring injuries at a level one trauma center was performed. Patients ≥ 15 years, treated with SI-screw fixation were included. EXCLUSION CRITERIA pathologic fractures, missing consent and navigated procedures. The primary outcome parameters was defined as SI-screw revision operations. Patients were stratified according to treatment strategy (RS: Rescue Screws; EL: elective SI-screws). RESULTS From 392 patients identified between 11/2014 and 08/2021, 186 met the inclusion criteria with 41 in the RS Group and 145 in the EL group. After matching, 41 patients were included in each group with similar baseline characteristics except persistent hemodynamic shock (RS: n = 22 (53.37%) vs. EL: n = 1 (4.3%), p < 0.001). Surgical characteristics were comparable in terms of instrumentation levels and insertion-sites. No significant differences were observed in the outcome parameters (revisions, reoperations, implant-associated complications, LOS and mortality) between both groups. CONCLUSION Treatment of unstable pelvic ring fractures with Rescue Screws appears as a feasible treatment option for emergency stabilization. Rescue Screws are not associated with elevated revision rates and increased complications rates. This minimally invasive technique enables safe emergency stabilization of the posterior pelvic ring. Prospective or randomized clinical trials are required to directly compare Rescue Screws with other competing emergency stabilization techniques.
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Affiliation(s)
- Felix Karl-Ludwig Klingebiel
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland.
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland.
| | - Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Octavia Klee
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Anhua Long
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Michel Teuben
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Henrik Teuber
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Till Berk
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Neuhaus
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100, Zurich, 8091, Switzerland
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Kußmaul AC, Bruder J, Greiner A, Woiczinski M, Thorwächter C, Dotzauer F, Rubenbauer B, Linhart C, Böcker W, Becker CA. Uncemented hip revision cup as an alternative for T-type acetabular fractures: A cadaveric study. Orthop Traumatol Surg Res 2024; 110:103797. [PMID: 38142779 DOI: 10.1016/j.otsr.2023.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current rise in elderly patients with compromised bone quality complicates the surgical treatment of acetabular T-type fractures (AO type 62B2 fractures). There is on ongoing discussion about the treatment options, mostly consisting of an open reduction and internal fixation (ORIF) with or without primary or secondary total hip arthroplasty (THA). Yet, these patients are oftentimes unable to fulfil weight-bearing restrictions and mostly present with an unavailability of a stable anchor site. Consequently, this study investigates the feasibility of a cementless hip revision cup for acetabular T-type fractures and compares its biomechanical properties to ORIF. HYPOTHESIS The cementless hip revision cup provides sufficient biomechanical stability under the simulation of full weight-bearing. PATIENTS AND METHODS The study compared two groups of human cadaveric hip bones with T-type fractures, of whom 6 subjects were treated with ORIF (6 male; mean age: 62±17years; mean body weight: 75±15) versus 6 subjects treated with a cementless hip revision cup (2 male; 69±12 years; 73±15kg). The group-assignment was controlled for comparable BMD results (mean BMD: ORIF 110±37 mg Ca-Ha/mL versus hip revision cup 134±32 mg Ca-Ha/mL). To compare for biomechanical stability cyclic loading was applied measuring the force and dislocation of the fracture gap at standardized bone loci using an all-electric testing machine and a 3D-ultrasound measuring system. RESULTS Comparing superior pubic ramus versus iliac wing (cementless hip revision cup versus ORIF [mean±standard deviation]: 5.8±2.0 versus 7.0±3.2; p=0.032) as well as sacral ala versus iliac wing (4.6±2.2 versus 6.4±3.7; p=0.002), the cementless revision cup achieved a significantly higher stability than the plate osteosynthesis. CONCLUSION Revision cup and ORIF withstood biomechanical loading forces exceeding full weight-bearing in this biomechanical study. The results of our study suggest that the cementless hip revision cup might be promising alternative to the current standard care of ORIF with or without primary THA. LEVEL OF EVIDENCE III; case control experimental study.
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Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan Bruder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Fabian Dotzauer
- Department for Trauma and Orthopaedic Surgery, Kreiskliniken Dillingen Wertingen, Wertingen, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christopher A Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Xing B, Shen X, Ma L, Qi X. TiRobot-Assisted Percutaneous Cannulated Screw Fixation for Elderly Patients with Fragility Fractures of the Pelvis: A Retrospective Study. Orthop Surg 2024; 16:662-674. [PMID: 38384135 PMCID: PMC10925510 DOI: 10.1111/os.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The incidence of fragility fractures of the pelvis (FFPs) is increasing in the elderly population, and FFPs that require fixation are a challenge for orthopedic surgeons. The insertion of implants is not risk free due to the complex anatomical and osteoporotic bones and requires a steep learning curve. This study aimed to investigate the clinical efficacy of TiRobot-assisted percutaneous cannulated screw fixation in the treatment of elderly FFP patients. METHOD The clinical data of 46 elderly FFP patients who had been treated with percutaneous cannulated screw fixation from May 2020 to September 2022 were retrospectively analyzed. Twenty-four patients were treated with percutaneous cannulated screw fixation assisted by the TiRobot (TiRobot-assisted group) and 22 patients were treated with conventional freehand surgery (freehand group). Postoperative outcomes, including Matta value, excellent and good rate (EGR) of fracture reduction, and accuracy of screw placement (ASP), were compared. Changes in the Visual analog scale (VAS) pain score and the Majeed score were recorded and compared between groups before and after surgery and during the 24-week follow-up. Repeated-measures analysis of variance (ANOVA) and effect sizes were used as analysis methods. RESULTS A total of 90 screws were implanted, 51 screws in the TiRobot-assisted group and 39 screws in the freehand group. The operation time of the two groups was 34.1 ± 2.67 min versus 64.5 ± 4.19 min (p < 0.001). There were no screw-related complications or revision surgeries in any group. The Matta value of the TiRobot-assisted group was 5.13 ± 3.52, which was significantly lower than that of the freehand group (9.00 ± 3.68, p < 0.001), while the EGR was 91.67% versus 72.73%, with statistical significance (p < 0.001). The ASP was 100% in the TiRobot-assisted group, better than that in the freehand group, where it was 85.7% (p = 0.043). At each timepoint in the early postoperative period, the VAS score of the TiRobot-assisted group was significantly lower than that of the freehand group and was close to consistent by the last follow-up; the Majeed score of the former was significantly higher than that of the latter at each timepoint of follow-up, with statistical significance (p < 0.001). CONCLUSION TiRobot-assisted percutaneous cannulated screw fixation of elderly FFP patients is advantageous over conventional freehand surgery, with less invasion, more accurate screw placement, better fracture reduction, early pain relief, and rapid recovery, suggesting that Freehand method to stabilize FFP in the elderly population.
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Affiliation(s)
- Baorui Xing
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Department of Orthopaedic SurgeryHebei Cangzhou Hospital of Integrated Traditional Chinese and Western MedicineCangzhouChina
| | - Xiaoyu Shen
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Lijie Ma
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xiangbei Qi
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Du S, Li X, Wei C, Ma Y, Liu J, Wu Y. Comparison of the operation safety and biomechanical stability of sacral alar-iliac vs. sacroiliac screws in the fixation of sacroiliac joint in simulated models of low bone density. Injury 2024; 55:111191. [PMID: 37972487 DOI: 10.1016/j.injury.2023.111191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sacral alar-iliac screws (SAISs) have been used for sacroiliac joint and are superiority to traditional sacroiliac screws (SISs) in patients with low bone density. The aim of this study was to investigate the operation safety and biomechanical stability of the SIS, transsacral-transiliac screw (TSTIS), S1AIS and S2AIS in the treatment of sacroiliac joint in simulated models of low bone density. METHODS CT data from 80 normal pelvic structures were employed to measure the anatomical parameters, including the safety zones of the S1AIS and S2AIS at the insertion point and the trajectory lengths of the SIS, TSTIS, S1AIS and S2AIS. Sixteen synthetic pelvises with simulated osteoporotic bone structure were used to simulate type C Tile lesions and divided into 4 groups with an anterior plate and posterior fixation using one of the following: 1) one SIS on each side, 2) one TSTIS fixing both sides, 3) one S1AIS on each side, or 4) one S2AIS on each side. The stiffness and maximum load of the specimens were analyzed using a biomechanical machine under vertical loading. RESULTS The safety zone of S1AIS was larger than that of S2AIS (p < 0.05). The TSTIS had the largest trajectory length, followed by the S1AIS and S2AIS, and the SIS had the smallest trajectory length (p < 0.05). However, the lengths of the TSTIS (26.1 ± 1.7 mm) and SIS (27.8 ± 1.8 mm) trajectories on the short side (the iliac side) were smaller than those of S1AIS (40.4 ± 3.8 mm) and S2AIS (39.1 ± 3.8 mm), thus indicating significant differences (p < 0.05). The stiffness and maximum load of S1AIS and S2AIS were similar and the greatest, followed by TSTIS and SIS (p < 0.05). CONCLUSION The stability of S1AIS and S2AIS is similar, both stronger than that of SIS and TSTIS, which have shorter lengths of the screw trajectories on the ilium side. However, the safety zone of S2AIS at the insertion point is smaller than that of S1AIS. Therefore, considering both safety and stability, S1AIS is the preferred choice for fixation of sacroiliac joint dislocation in simulated models of low bone density.
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Affiliation(s)
- Shihao Du
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Xin Li
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Changbao Wei
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Yunhong Ma
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China.
| | - Jun Liu
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Yongwe Wu
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
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Kalbas Y, Hoch Y, Klingebiel FKL, Klee O, Cester D, Halvachizadeh S, Berk T, Wanner GA, Pfeifer R, Pape HC, Hasler RM. 3D-navigation for SI screw fixation - How does it affect radiation exposure for patients and medical personnel? Injury 2024; 55:111214. [PMID: 38029680 DOI: 10.1016/j.injury.2023.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND 3D-navigation for percutaneous sacroiliac (SI) screw fixation is becoming increasingly common and several studies report great advantages of this technology. However, there is still limited clinical evidence on the efficacy regarding radiation exposure for patient and personnel. METHODS This is a retrospective, single-center cohort study. All patients who underwent percutaneous sacroiliac screw fixation for an injury of the posterior pelvic ring from 2014 to 2021 were screened. Inclusion criteria were: conclusive radiation dosage reports, signed informed consent, a twelve month follow up and a complete data set. Patients were stratified in two groups (3D-navigation (Group 3D-N) vs. control (Group F)) based on the imaging modality used. Primary outcomes were radiation exposure for patient and personnel. Secondary outcomes were reoperations, complications, and intraoperative precision. RESULTS Of 392 patients screened, 174 patients (3D-N: n = 50, F: n = 124) could be included for final analysis. We noted a significant reduction of the dose corresponding to potential radiation exposure for medical personnel (-15.3 mGy, 95 %CI: -2.1 to -28.5, p = 0.0232), but also a significant increase of the dose quantifying radiation exposure for patients (+77.0 mGy, 95 %CI: +53.3 to +100.6, p < 0.0001), when using navigation. In addition, the rate of radiographic malplacement was significantly reduced (F: 11.3% vs. 3D-N: 0 %, p = 0.0113) despite a substantial increase in transsacral screw placement (F: 19.4% vs. 3D-N: 76 %). CONCLUSION Our data clearly suggests that the use of 3D-navigation for percutaneous SI screw fixation decreases radiation exposure for medical personnel, while increasing radiation exposure for patients. Furthermore, intraoperative precision is improved, even in more challenging operations.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland.
| | - Yannis Hoch
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Felix Karl-Ludwig Klingebiel
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Octavia Klee
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Davide Cester
- University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Till Berk
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Guido A Wanner
- Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Center for Spine Surgery and Trauma Surgery, Bethanien Hospital, Toblerstr. 51 8044 Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland
| | - Rebecca Maria Hasler
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Prodorso Center for Spine Medicine, Walchestr. 15 CH-8006 Zürich, Switzerland
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Grüneweller N, Leunig J, Zderic I, Gueorguiev B, Wähnert D, Vordemvenne T. Stabilization of Traumatic Iliosacral Instability Using Innovative Implants: A Biomechanical Comparison. J Clin Med 2023; 13:194. [PMID: 38202203 PMCID: PMC10779522 DOI: 10.3390/jcm13010194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Demographic changes over the past decade have had a significant impact on pelvic ring fractures. They have increased dramatically in the orthogeriatric population. Surgeons are faced with implant fixation issues in the treatment of these fragility fractures. This study compares two innovative implants for stabilizing the iliosacral joint in a biomechanical setting. (2) Methods: An iliosacral screw with a preassembled plate allowing the placement of an additional short, angular stable screw in the ilium and a triangular fixation system consisting of a fenestrated ilium screw and an iliosacral screw quasi-statically inserted through the "fenestra" were instrumented in osteoporotic artificial bone models with a simulated Denis zone 1 fracture. Biomechanical testing was performed on a servo-hydraulic testing machine using increasing, synchronous axial and torsional sinusoidal cyclic loading to failure. (3) Results: The SI-Plate and TriFix showed comparable stiffness values. The values for fracture gap angle and screw tip cutout were significantly lower for the TriFix compared to the SI-Plate. In addition, the number of cycles to failure was significantly higher for the TriFix. (4) Conclusions: Implant anchorage and primary stability can be improved in iliosacral instability using the triangular stabilization system.
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Affiliation(s)
- Niklas Grüneweller
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
| | - Julia Leunig
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Dirk Wähnert
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
| | - Thomas Vordemvenne
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
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Cintean R, Fritzsche C, Zderic I, Gueorguiev-Rüegg B, Gebhard F, Schütze K. Sacroiliac versus transiliac-transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison. Eur J Trauma Emerg Surg 2023; 49:2553-2560. [PMID: 37535095 PMCID: PMC10728224 DOI: 10.1007/s00068-023-02341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Pelvic fractures were often associated with high-energy trauma in young patients, but data show a significant increase in osteoporotic pelvic fractures in old age due to the progressive demographic change. There is an ongoing discussion about the best fixation techniques, which are ranging from lumbopelvic fixation to sacral bars or long transiliac-transsacral (TITS) screws. This study analyzes TITS screw osteosynthesis and sacroiliac screw osteosynthesis (SI), according to biomechanical criteria of fracture stability in osteoporotic human pelvic cadavers ex vivo. METHODS Ten osteoporotic cadaveric pelvises were randomized into two groups of 5 pelvises each. An FFP-IIc fracture was initially placed unilaterally and subsequently surgically treated with a navigated SI screw or a TITS screw. The fractured side was loaded in a one-leg stance test setup until failure. Interfragmentary movements were assessed by means of optical motion tracking. RESULTS No significant difference in axial stiffness were found between the SI and the TITS screws (21.2 ± 4.9 N and 18.4 ± 4.1 N, p = 0.662). However, there was a significantly higher stability of the fracture treatment in the cohort with TITS-screws for gap angle, flexion, vertical movement and overall stability. The most significant difference in the cycle interval was between 6.000 and 10.000 for the gap angle (1.62 ± 0.25° versus 4.60 ± 0.65°, p = 0.0001), for flexion (4.15 ± 0.39 mm versus 7.60 ± 0.81 mm, p = 0.0016), interval 11.000-15.000 for vertical shear movement (7.34 ± 0.51 mm versus 13.99 ± 0.97 mm, p < 0.0001) and total displacement (8.28 ± 0.66 mm versus 15.53 ± 1.07 mm, p < 0.0001) for the TITS and the SI screws. CONCLUSIONS The results of this biomechanical study suggest a clear trend towards greater fracture stability of the TITS screw with significantly reduced interfragmentary movement. The application of a TITS screw for the treatment of the osteoporotic pelvic ring fracture may be prioritized to ensure the best possible patient care.
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Affiliation(s)
- Raffael Cintean
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Cornelius Fritzsche
- Department of Handsurgery, Upper Extremities and Foot Surgery, Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany
| | - Ivan Zderic
- AO Research Institute (ARI), Clavandelerstrasse 8, 7270, Davos Platz, Switzerland
| | | | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Konrad Schütze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Chiang JB, Yee DKH. A Toolbox of Bone Consolidation for the Interventional Radiologist. Cardiovasc Intervent Radiol 2023; 46:1447-1457. [PMID: 37165213 DOI: 10.1007/s00270-023-03445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
Bone consolidation is increasingly used in the treatment of both benign and malignant bone conditions. Percutaneous vertebroplasty, for example, has been shown to be useful in vertebral compression fractures in the VAPOUR trial which showed its superiority to placebo for pain reduction in the treatment of acute vertebral compressive fractures. Further tools have since been developed, such as kyphoplasty, spinal implants, and even developments in bone cements itself in attempt to improve outcome, such as chemotherapy-loaded cement or cement replacements such as radio-opaque silicon polymer. More importantly, bone fixation and its combination with cement have been increasingly performed to improve outcome. Interventional radiologists must first know the tools available, before they can best plan for their patients. This review article will focus on the tool box available for the modern interventional radiologist.
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Affiliation(s)
- Jeanie Betsy Chiang
- Block K Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Yau Ma Tei, Kowloon, Hong Kong SAR, China.
| | - Dennis King Hang Yee
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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10
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Optimal insertion positions of anterior-posterior orientation sacroiliac screw. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1383-1392. [PMID: 36746804 DOI: 10.1007/s00586-023-07568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the optimal insertion positions of anterior-posterior orientation sacroiliac screw (AP-SIS). METHODS Pelvic CT data of 80 healthy adults were employed to measure the anatomical parameters including the insertable ranges of S1 and S2, the length, width and height of the channel with three different horizontal and vertical anterior insertion points starting from the ilium-acetabular recess. To compare pelvic stability by replicating a type C Tile lesions, fifteen synthetic pelvises were fixed with an anterior plate and a posterior AP-SIS employing different anterior insertion points, the whole specimen displacements and shifts in the sacroiliac gap under a cyclic vertical load of 300 N in a biomechanical machine recorded. RESULTS The posterior and anterior insertable ranges averaged 17.9 × 8.5mm2 and 47.1 × 21.2 mm2, respectively. The channel lengths for three horizontal anterior insertion points gradually decreased from front to back with significant difference (p < 0.05), whereas the width and height for three horizontal anterior insertion points and the parameters for the three vertical anterior insertion points were similar (p > 0.05). The displacements and shifts for three horizontal insertion points gradually increased from front to back (p < 0.05) whereas the measurements involving the three vertical insertion points were similar (p > 0.05). CONCLUSION The posterior insertable range is small, where the center between adjacent nerve roots (foramens) is the optimal posterior insertion point. The anterior insertable range is large, where the iliac-acetabular recess is the optimal anterior insertion point for S1 and S2, providing the longest channel and best stability.
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11
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You MR, Fan ZQ, Ye HM, Wang Z, Zou CH, Dong XP. The design and application of an individualized 3D printing assisted guide plates in assisting sacroiliac screws insertion. Comput Assist Surg (Abingdon) 2022; 27:113-119. [PMID: 35867539 DOI: 10.1080/24699322.2022.2102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Currently, the sacroiliac screws insertion still faces several challenges in the fixation of pelvic and acetabular injuries. This study was aimed to design a personalized three-dimensional (3D) printing assisted guide plates to assist sacroiliac screws insertion, so as to provide a reference for further clinical applications. METHODS Eight pelvic specimens (5 males and 3 females) of normal adults were used to simulate actual operation. After thin-layer CT scanning, the 3D models of pelvis were established based on the images data. Furthermore, in Mimics 17.0 software, the screw entry points and screw channels of sacroiliac screws were further simulated and designed, and the appropriate range of the posterior superior iliac spine was selected to establish and print the virtual guide plates. Then, the simulated screws insertion was performed in vitro, the pelvic specimens after screws insertion were scanned again by CT, and the effect of screws insertion was further evaluated. RESULTS A total of 16 sacroiliac screw guide plates were designed and printed, and 48 screws were inserted on both sides. Therein, 45 screws were completely located in the sacral vertebra, which was determined as grade 0, with an accuracy rate of 93.2%. The other 3 screws penetrated the anterior cortex or sacral canal of sacral vertebra, including 2 screws in Grade 1 (4.1%) and 1 screw in Grade 2 (2.1%). Compared with the simulated screw channels, the anterior and posterior offset angles of the cross section were (0.912 ± 0.625) ° and (0.802 ± 0.681) ° respectively, with no significant difference (p > 0.05). The upper and lower offset angles of coronal plane were (1.158 ± 0.823) ° and (1.034 ± 0.908) ° respectively, and there was no significant difference (p > 0.05). CONCLUSIONS 3 D printing guide plates assisted sacroiliac screws insertion can enhance the stability of pelvic posterior ring fixation and assist surgeons to reduce the difficulty of operation.
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Affiliation(s)
- Mu-Rong You
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhi-Qiang Fan
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hai-Min Ye
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhe Wang
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Chun-Hua Zou
- Department of Radiology,Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xie-Ping Dong
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Radio-anatomical study of anterior-posterior placement sacroiliac screw channel. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2572-2578. [PMID: 35687271 DOI: 10.1007/s00586-022-07257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/19/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The outlet of the classic sacroiliac screw (SIS) cannot be precisely controlled by aiming devices, which may lead to malpositioned implants and neurovascular and visceral injury. This study aimed to radio-anatomically measure the parameters of the channel for anterior-posterior placement SIS (AP-SIS), which can be placed percutaneously with an aiming device. METHODS Pelvic CT scan data of 80 healthy adults (40 males and 40 females) with an average age of 45 years (range 20-70 years) were collected. The length (L), width (W), height (H), cortical bone spacing (M), camber angle (E), anteversion angle (F), cross-sectional safety angle (P) and sagittal safety angle (Q) of the channel were measured by CT or Mimics software. RESULTS The L, W, H, M, E, F, P and Q measures of S1 were 109.2 ± 8.0 mm, 18.5 ± 1.9 mm, 21.7 ± 1.7 mm, 8.1 ± 0.4 mm, 44.2 ± 3.2°, 42.4 ± 3.6°, 16.8 ± 1.1°, and 19.4 ± 2.0°, respectively, for S1, and 113.5 ± 9.4 mm, 18.2 ± 1.5 mm, 21.7 ± 1.7 mm, 7.7 ± 0.4 mm, 44.7 ± 3.2°, 31.2 ± 2.7°, 13.8 ± 1.0° and 15.4 ± 1.4°, respectively, for S2. Of the L measures, the intra-iliac segment was slightly longer than the intra-sacral segment. All parameters showed significant sex-related differences (p < 0.05). CONCLUSION The AP-SIS channels of S1-2 have sufficient width and length to accommodate a cancellous screw with a Φ 7.0-8.0 mm and a length 90-130 mm. The intra-iliac segment is a long channel screw with better mechanical properties over classic SIS.
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Chen H, Ding C, Liu Y, Kong Z, Chang S, Huang F, Li H, Guo Q, Yang Y, Zhong H, Yang S. A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury. J Orthop Surg Res 2022; 17:285. [PMID: 35597957 PMCID: PMC9124380 DOI: 10.1186/s13018-022-03133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study is to compare the clinical and biomechanical outcome of INFIX plus single with two sacroiliac screw fixation for unstable pelvic fractures of Type C. METHODS Sixteen cadavers were randomly subjected to INFIX plus single or double sacroiliac screw fixations and then mounted onto the ElectroForce loading machine under different vertical loads. To investigate the clinical outcomes of the two techniques, nineteen patients were retrospectively analyzed. The main outcome measures were postoperative radiographic reduction grading (using the Tornetta and Matta grading system), functional outcome (using the Majeed scoring system), and incidence of complications. RESULTS In the biomechanical study, INFIX plus double sacroiliac screw fixation showed better biomechanical stability than fixation with a single sacroiliac screw (p < 0.05). In our clinical case series, all 19 patients had bony union 6 months after the operation. INFIX plus double sacroiliac screw fixation also demonstrated a better functional outcome and a higher radiographic satisfactory rate than INFIX plus single sacroiliac screw fixation (79.25 ± 5.47; 91.33 ± 4.97; p < 0.05), (77.78% vs. 60%; p = 0.05). One patient in INFIX plus single-screw fixation group had screw loosening at 6-month follow-up postoperatively. One case in each group suffered heterotopic ossification and the lateral femoral cutaneous nerve paralysis, and one patient suffered from infection. CONCLUSION INFIX plus double sacroiliac screw fixation demonstrated more stability in cadaveric biomechanical analysis and better clinical outcomes than INFIX plus single sacroiliac screw fixation.
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Affiliation(s)
- Hongfen Chen
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Chao Ding
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Yongqiang Liu
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Zhen Kong
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Siling Chang
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Feng Huang
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Heng Li
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Qingxiang Guo
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Yuehua Yang
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 People’s Republic of China
| | - Hua Zhong
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
| | - Shaozheng Yang
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, No. 566 Congcheng Avenue, Conghua District, Guangzhou, 510900 People’s Republic of China
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Cavalcanti Kußmaul A, Schwaabe F, Becker CA, Kleber C, Linhart C, Thorwächter C, Rubenbauer B, Böcker W, Greiner A. Does augmentation increase the pull-out force of symphyseal screws? A biomechanical cadaver study. Eur J Trauma Emerg Surg 2022; 48:4215-4221. [PMID: 35364692 PMCID: PMC9532288 DOI: 10.1007/s00068-022-01963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
Purpose Open reduction and internal fixation using anterior plate osteosynthesis currently represents the gold standard for the treatment of symphyseal disruptions. Since postoperative screw loosening with consequent implant failure is frequently observed, this study aims to evaluate if and to what extent augmentation can increase the pull-out force of symphyseal screws to improve the constructs stability. Methods Twelve human cadaveric anterior pelvic rings were separated at the symphyseal joint for bilateral testing, consequently achieving comparable sites. First, one non-augmented screw was drilled into the superior pubic ramus, whereas the contralateral side was primarily augmented. The screws were then withdrawn with a constant speed of 10 mm/min and the fixation strengths determined by the force (N) displacement (mm) curve. Finally, the primary non-augmented site was secondary augmented, representing revision surgery after initial implant failure, and the corresponding fixation strength was measured again. Results Augmentation compared to non-augmented screws displayed significantly higher pull-out forces with an increase in pull-out force by 377% for primary and 353% for secondary augmentation (p < 0.01). There was no significant difference in the pull-out force comparing primary and secondary augmentation (p = 0.74). Conclusions Primary and secondary augmentation significantly increases the stability of symphyseal screws and, therefore, potentially decreases rates of implant failure. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01963-6.
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Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Fanny Schwaabe
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher Alexander Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kleber
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Heiman E, Gencarelli P, Tang A, Yingling JM, Liporace FA, Yoon RS. Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literature. Hip Pelvis 2022; 34:69-78. [PMID: 35800130 PMCID: PMC9204239 DOI: 10.5371/hp.2022.34.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.
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Affiliation(s)
- Erick Heiman
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Pasquale Gencarelli
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John M. Yingling
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
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Hack J, Safi M, Bäumlein M, Lenz J, Bliemel C, Ruchholtz S, Oberkircher L. Is cement-augmented sacroiliac screw fixation with partially threaded screws superior to that with fully threaded screws concerning compression and pull-out force in fragility fractures of the sacrum? - a biomechanical analysis. BMC Musculoskelet Disord 2021; 22:1034. [PMID: 34893059 PMCID: PMC8665623 DOI: 10.1186/s12891-021-04933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Providing a stable osteosynthesis in fragility fractures of the pelvis can be challenging. Cement augmentation increases screw fixation in osteoporotic bone. Generating interfragmentary compression by using a lag screw also improves the stability. However, it is not known if interfragmentary compression can be achieved in osteoporotic sacral bone by cement augmentation of lag screws. The purpose of this study was to compare cement-augmented sacroiliac screw osteosynthesis using partially versus fully threaded screws in osteoporotic hemipelvises concerning compression of fracture gap and pull-out force. Methods Nine fresh-frozen human cadaveric pelvises with osteoporosis were used. In all specimens, one side was treated with an augmented fully threaded screw (group A), and the other side with an augmented partially threaded screw (group B) after generating a vertical osteotomy on both sides of each sacrum. Afterwards, first a compression test with fracture gap measurement after tightening of the screws was performed, followed by an axial pull-out test measuring the maximum pull-out force of the screws. Results The fracture gap was significantly wider in group A (mean: 1.90 mm; SD: 1.64) than in group B (mean: 0.91 mm; SD: 1.03; p = 0.028). Pull-out force was higher in group A (mean: 1696 N; SD: 1452) than in group B (mean: 1616 N; SD: 824), but this difference was not statistically significant (p = 0.767). Conclusions Cement augmentation of partially threaded screws in sacroiliac screw fixation allows narrowing of the fracture gap even in osteoporotic bone, while resistance against pull-out force is not significantly lower in partially threaded screws compared to fully threaded screws.
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Affiliation(s)
- Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany.
| | - Maiwand Safi
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Julia Lenz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany
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How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study. Eur J Trauma Emerg Surg 2021; 48:3101-3108. [PMID: 34881391 PMCID: PMC9360150 DOI: 10.1007/s00068-021-01850-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Osteoporotic bone tissue appears to be an important risk factor for implant loosening, compromising the stability of surgical implants. However, it is unclear whether lumbar measured bone mineral density (BMD) is of any predictive value for stability of surgical implants at the pubic symphysis. This study examines the fixation strength of cortical screws in human cadaver specimens with different BMDs. METHODS The lumbar BMD of ten human specimens was measured using quantitative computed tomography (qCT). A cut-off BMD was set at 120 mg Ca-Ha/mL, dividing the specimens into two groups. One cortical screw was drilled into each superior pubic ramus. The screw was withdrawn in an axial direction with a steady speed and considered failed when a force decrease was detected. Required force (N) and pull-out distance (mm) were constantly tracked. RESULTS The median peak force of group 1 was 231.88 N and 228.08 N in group 2. While BMD values differed significantly (p < 0.01), a comparison of peak forces between both groups showed no significant difference (p = 0.481). CONCLUSION Higher lumbar BMD did not result in significantly higher pull-out forces at the symphysis. The high proportion of cortical bone near the symphyseal joint allows an increased contact of pubic screws and could explain sufficient fixation. This condition is not reflected by a compromised lumbar BMD in a qCT scan. Therefore, site-specific BMD measurement could improve individual fracture management.
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Wilson DGG, Kelly J, Rickman M. Operative management of fragility fractures of the pelvis - a systematic review. BMC Musculoskelet Disord 2021; 22:717. [PMID: 34419037 PMCID: PMC8380328 DOI: 10.1186/s12891-021-04579-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate stabilisation of these injuries to reduce pain, facilitate early mobilisation, decrease hospital stay and restore independence. A systematic review of the literature was planned to establish the evidence for this intervention. Methods A systematic review was performed according to PRISMA guidelines. A clinical librarian performed a search of the following databases: NHS Evidence, TRIP, the Cochrane Database of Systematic Reviews, MEDLINE and EMBASE. Seventeen eligible studies were identified with 766 patients. Results The quality of evidence was poor with no good quality randomised trials. The majority of injuries were minimally displaced. Posterior ring injuries were most often stabilised with percutaneous screws which were sometimes augmented with void filler. A number of techniques were described for stabilisation of the anterior ring although fixation of the anterior ring was frequently not performed. There was consistent evidence from the included studies that operative intervention significantly improved pain. Complications were minimal but there were increased failure rates when a single unaugmented sacroiliac joint screw was used. The limited availability of non-operative comparators made it difficult to draw firm conclusions about the efficacy of surgical over non-surgical management in these patients. Conclusions Operative management of fragility fractures of the pelvis should be considered for patients failing a brief period of non-operative management, however prospective randomised trials need to be performed to provide improved evidence for this intervention. Surgeons should consider which fixation techniques for fragility fractures of the pelvis are robust enough to allow immediate weightbearing, whilst minimising operative morbidity and post-operative complications. PROSPERO Systematic Review ID: CRD42020171237. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04579-w.
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Affiliation(s)
- Daniel G G Wilson
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia. .,, Present address: Brighton, UK.
| | - Joshua Kelly
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Mark Rickman
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, 5005, Australia
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Wagner D, Kisilak M, Porcheron G, Krämer S, Mehling I, Hofmann A, Rommens PM. Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis. Sci Rep 2021; 11:14201. [PMID: 34244526 PMCID: PMC8270908 DOI: 10.1038/s41598-021-93559-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022] Open
Abstract
Operative treatment of osteoporosis-associated fragility fractures of the pelvis (FFP) and the sacrum is advocated with immobilizing or longstanding pain, fracture progression and displacement. We analyzed clinical outcomes regarding mobility, quality of life, and mortality of patients with FFP treated with trans-sacral bar (TB) osteosynthesis through S1. Demographics, clinical data, and operation-related data of patients with an FFP treated with TB were acquired from chart review. We assessed mortality, quality of life (EQ-5D), mobility, and residential status at follow-up. Seventy-nine females and six males with a median age of 78.0 years (IQR 73–84) were included, median follow-up was 3.2 years. Medical complications during hospitalization occurred in 28%. Operative revision was carried out in 15% of patients. One-year survival was 90.4%, this was associated with shorter preoperative and total length of stay in hospital (p 0.006 and 0.025, respectively). At follow-up, 85% lived at home and 82% walked with or without walking aid. Higher EQ-5D was reached with higher mobility status and living at home (p < 0.001 and < 0.001, respectively). TB osteosynthesis is an adequate and reliable method for fixation of FFP in the posterior pelvic ring to ensure timely mobilization. Shorter preoperative and total length of stay had lower mortality rates, advocating a standardized management protocol to limit time delay to operative therapy. Patients treated with TB osteosynthesis had low 1-year mortality of less than 10%.
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Affiliation(s)
- Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Miha Kisilak
- Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Geoffrey Porcheron
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sven Krämer
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Isabella Mehling
- Division of Hand Surgery, St. Vincent Hospital Hanau, Hanau, Germany
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Hartensuer R, Lodde MF, Keller J, Eveslage M, Stolberg-Stolberg J, Riesenbeck O, Raschke MJ. Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation-A 15-Year Retrospective Analysis on over 640 Screws. J Clin Med 2020; 9:jcm9082660. [PMID: 32824548 PMCID: PMC7463525 DOI: 10.3390/jcm9082660] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Minimally invasive sacroiliac-screw (SI-screw) fixation of the pelvis is used in energy trauma (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classified) and fragility fractures (Fragility Fracture of the Pelvis (FFP) classified). However, available clinical data are based on small case series and biomechanical data seem to be contradictory. METHODS The present single center retrospective cohort study investigated percutaneous SI-screw fixation and augmentation over 15 years. Groups were compared concerning the general epidemiological data, mobilization, complication rates, duration of stay, and safety of SI-screw insertion. Multivariable analyses were performed using logistic regression. RESULTS Between 2005 and March 2020, 448 patients with 642 inserted SI-screws were identified. Iatrogenic neurological impairment was documented in 2.47% and correlated with screw misplacement. There was an increased complication risk in patients with AO type C over patients with AO type B and in FFP II over FFP III/IV patients. Cement-augmented FFP patients showed a 25% reduced stay in hospital and a reduced complication risk. Cement-associated complications were seen in 22% without correlation to neurologic impairment. CONCLUSIONS The present study confirms the safety and usability of percutaneous SI-screw fixation, despite specific risks. Cement augmentation seems to reduce the complication risk in FFP patients and shorten hospital stay for some reasons, without increased specific complications or correlated neurological impairment.
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Affiliation(s)
- René Hartensuer
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
- Correspondence: ; Tel.: +49-251-83-59204
| | - Moritz F. Lodde
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Jonas Keller
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Münster, Germany;
| | - Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Oliver Riesenbeck
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
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Zeckey C, Cavalcanti Kußmaul A, Suero EM, Kammerlander C, Greiner A, Woiczinski M, Braun C, Flatz W, Boecker W, Becker CA. The T-pod is as stable as supraacetabular fixation using 1 or 2 Schanz screws in partially unstable pelvic fractures: a biomechanical study. Eur J Med Res 2020; 25:26. [PMID: 32682448 PMCID: PMC7368791 DOI: 10.1186/s40001-020-00427-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Unstable fractures of the pelvis remain the predominant cause of severe hemorrhage, shock and early death in severely injured patients. The use of pelvic binders has become increasingly popular, particularly in the preclinical setting. There is currently insufficient evidence available about the stability of the pelvic binder versus supraacetabular fixation using 1 or 2 Schanz screws. We aimed to analyze the stability of the pelvic binder and supraacetabular fixateurs using either 1 or 2 Schanz screws in a cadaver model of an induced pelvic B-type fracture. MATERIALS AND METHODS The study was undertaken in 7 human fresh-frozen cadaveric pelvises with induced AO-type B fractures. Three stabilization techniques were compared: T-POD (pelvic bandage), supraacetabular external fixator with 1 pin on each side and external fixator with 2 pins on each side. Stability and stiffness were analyzed in a biomechanical testing machine using a 5-step protocol with static and dynamic loading, dislocation data were retrieved by ultrasound sensors at the fracture sites. RESULTS No significant differences in fracture fragment displacement were detected when using either the T-POD, a 1-pin external fixator or a 2-pin external fixator (P > 0.05). The average difference in displacement between the three methods was < 1 mm. CONCLUSIONS Pelvic binders are suitable for reduction of pelvic B-type fractures. They provide stability comparable to that of supraacetabular fixators, independently of whether 1 or 2 Schanz screws per side are used. Pelvic binders provide sufficient biomechanical stability for transferring patients without the need to first replace them with surgically applied external fixators. However, soft tissue irritation has to be taken into consideration and prolonged wear should be avoided. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Christian Zeckey
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eduardo M Suero
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Axel Greiner
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Braun
- Institute of Legal and Forensic Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Wilhelm Flatz
- Institute for Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Wolfgang Boecker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher A Becker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
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