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Liu X, Gao J, Wu X, Deng J, Li Z, Li R, Zhang L, Liu J, Li M. Comparison between Novel Anatomical Locking Guide Plate and Conventional Locking Plate for Acetabular Fractures: A Finite Element Analysis. Life (Basel) 2023; 13:2108. [PMID: 38004248 PMCID: PMC10671966 DOI: 10.3390/life13112108] [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: 09/11/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of complex acetabular fractures remains a complicated clinical challenge. Our self-designed novel anatomical locking guide plate (NALGP) has previously shown promising potential in T-shaped acetabular fractures (TAF), but a direct comparison with conventional fixations is yet to be made. The TAF model was established based on a volunteer's computer tomography data and then fixed with double column locking plates (DLP), a posterior column locking plate with anterior column screws (LPACS), and our NALGP. Forces of 200 N, 400 N, and 600 N were then loaded on the model vertically downward, respectively. The stress distribution and peaks and maximum displacements at three sites were assessed. We found that the stress area of all three plates was mainly concentrated around the fracture line, while only the matching screws of the NALGP showed no obvious stress concentration points. In addition, the NALGP and DLP showed significantly less fracture fragment displacement than the LPACS at the three main fracture sites. The NALGP was found to have less displacement than DLP at the posterior column and ischiopubic branch sites, especially under the higher loading forces of 400 N and 600 N. The fixation stability of the NALGP for TAF was similar to that of DLP but better than that of LPACS. Moreover, the NALGP and its matching screws have a more reasonable stress distribution under different loads of force and the same strength as the LPACS.
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Affiliation(s)
- Xiao Liu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Jianpeng Gao
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Xiaoyong Wu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Junhao Deng
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Zijian Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Ran Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Licheng Zhang
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Jianheng Liu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Ming Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
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Şibar K, Alemdaroğlu KB, Elibol FKE, Çalişkan Öİ, Demir T. Talon cannulated compression device as an alternative in the fixation of acetabulum posterior column fractures: A biomechanical study. Injury 2023; 54:110964. [PMID: 37573841 DOI: 10.1016/j.injury.2023.110964] [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: 06/12/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
To compare the amount of displacement and rigidity at the fracture line under static & dynamic axial loading and torsional stress of conventional cannulated screw (CS), plate screw fixation including inter-fragmentary screw (PL), and talon cannulated compression device or talon screw in other words (TS) in posterior column fracture models. Synthetic hemipelvis bone models presenting a posterior column fracture were used in this study. Group PL, CS, and TS were created with ten bone models prepared for each group for dynamic and static loading tests and another ten for torsional tests. Rigidity and displacement amounts before and after loading were measured at the reference points AL, BL, and CL, located at the acetabulum's top, middle, and bottom, respectively. Torsional tests for each group were used to calculate torsional rigidity and maximum torque values. In dynamic axial loading tests, Group CS showed more displacement than PL at the BL point (p = 0,032) and Group TS at AL (p = 0,032) and CL (p = 0,004) points. In static axial loading tests, Group CS significantly displaced more than TS at AL and CL points (p = 0,05 and p = 0,014, respectively). Group PL and Group TS exhibited similar behavior in dynamic, static axial loading tests and torsional rigidity. The maximum torque that Group PL could withstand was statistically significantly higher than the other two groups (p <0,001). Talon cannulated screws had promising results in posterior column fractures of the acetabulum, which may decline the need for open surgery for stable fixation.
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Affiliation(s)
- Kemal Şibar
- SBÜ Ankara Training and Research Hospital, Ankara, Turkey.
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Adamović P, Kalajžić L, Hrman D, Kodvanj J, Sabalić S. Biomechanical analysis of a novel Y-plate designed for the treatment of extraarticular distal humerus fractures. Injury 2023:110840. [PMID: 37230827 DOI: 10.1016/j.injury.2023.110840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
Adult distal humerus fractures are infrequent, yet they account for one-third of all humerus fractures. For the treatment of comminuted and osteoporotic fractures, locking plates are claimed to be biomechanically superior to alternative internal fixing techniques. Treatment remains difficult despite recent advancements and the use of locking plates due to frequent comminution, low bone quality, and limited healing ability in osteoporotic bone. An optimal design of the newly constructed plate and the control model were selected. The biomechanical characteristics of non-osteoporotic and osteoporotic synthetic bone were compared on six models. The biomechanical properties of the new plate were tested and compared on 54 osteoporotic synthetic humerus models. The control models were reconstructive and parallel LCPs. The tests were carried out under static and dynamic axial, lateral and bending loads. Fracture displacements were measured by optical measuring system Aramis. The test model is significantly stiffer for lateral load (p = 0.0007) and for bending load at the moment of model failure (p = 0.0002), while for axial load the LCP model showed greater stiffness (p = 0.0017). During lateral dynamic loading, all three LCP models broke and there was a significant difference compared to the test model (p = 0.0125). The LCP model is dynamically significantly more durable under axial load, while the largest displacements were recorded with the test model (p = 0.029). The displacements induced by all three loads are within the limits that fulfil the parameters of appropriate biomechanical stability. A novel locking plate for extra-articular distal humerus fractures may provide an alternative to the traditional two-plate.
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Affiliation(s)
- Petra Adamović
- Experimental Mechanics Laboratory, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia.
| | - Lea Kalajžić
- Department of Diagnostic and Interventional Radiology, Sestre Milosrdnice University Hospital Center, Vinogradska Cesta 29, 10000 Zagreb, Croatia
| | - Danijela Hrman
- Probotica d.o.o., Slavonska avenija 6A, 10000 Zagreb, Croatia
| | - Janoš Kodvanj
- Experimental Mechanics Laboratory, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Srećko Sabalić
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, 10000 Zagreb, Croatia; School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
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Duan P, Ding X, Xiong M, Wang P, Xu S, Du W. Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis. J Orthop Surg Res 2023; 18:251. [PMID: 36973727 PMCID: PMC10044380 DOI: 10.1186/s13018-023-03736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Treatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator. METHODS A patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis. RESULTS Under the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3-13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases. CONCLUSIONS The acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.
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Affiliation(s)
- Pengyun Duan
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Xiaohong Ding
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China.
| | - Min Xiong
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Panfeng Wang
- Department of Orthopaedics, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Shipeng Xu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Wei Du
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
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Veeresh V, Bansal H, Mittal S, Trikha V. Fixation techniques for transverse acetabular fractures: Comparison of different biomechanical loading patterns. Injury 2022; 53:2385. [PMID: 33082030 DOI: 10.1016/j.injury.2020.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Vivek Veeresh
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hemant Bansal
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Samarth Mittal
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vivek Trikha
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Liu ZJ, Gu Y, Jia J. The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study. BMC Musculoskelet Disord 2022; 23:345. [PMID: 35410204 PMCID: PMC8996653 DOI: 10.1186/s12891-022-05313-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Transverse-oriented acetabular fractures (TOAFs), including transverse, transverse with posterior wall and T-shaped fractures, are always challenging for double-column reduction and fixation with minimally invasive method. The purpose of this study is to compare the therapeutic effects of robot-aided percutaneous anterior column screw fixation versus minimally invasive anterior plate fixation for TOAFs based on the Kocher-Langenbeck (K-L) approach. Methods Patients suffering TOAFs that were fixed by robot-aided percutaneous anterior column screw fixation or minimally invasive anterior plate fixation associated with posterior fixation via the K-L approach were divided into two groups: group A (screw fixation) and group B (plate fixation). Surgical time, blood loss, incision length for anterior fixation and complications were recorded. Fracture reduction quality was evaluated using criteria described by Matta. Fracture healing was assessed on the series of pelvic radiographs at each follow-up. Functional outcomes were investigated using the modified Postel Merle D’Aubigne score at the final follow-up. Results Twenty-nine patients with TOAFs, including 12 patients in group A and 17 patients in group B, were evaluated for study eligibility. The mean surgical time of anterior fracture fixation was 18.7 ± 4.6 min in group A and 33.4 ± 5.0 min in group B (P < 0.001). The amount of intraoperative blood loss was 615.6 ± 178.7 ml in group A and 719.3 ± 199.0 ml in group B (P < 0.001). Incision length for anterior fixation was 9.0 ± 1.8 mm in group A and 81.2 ± 7.3 mm in group B (P < 0.001). The complications related to the surgery of anterior column only occurred in group B (lateral femoral cutaneous nerve palsy in 1 patient and groin discomfort in 1 patient). No significant differences in reduction quality, hospital stay, fracture healing time and functional results were noted between the two groups. Conclusion The K-L approach combined with robot-aided anterior column screw fixation is a safe and effective option for TOAFs. Compared with minimally invasive anterior plate fixation, robot-aided screw fixation has obvious advantages on surgical time, blood loss, and invasiveness. The K-L approach combined with minimally invasive anterior plate fixation can also be a reliable alternative for TOAFs, with the similar reduction quality and functional results.
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Affiliation(s)
- Zhao-Jie Liu
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China
| | - Ya Gu
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China
| | - Jian Jia
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China.
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Hinz N, Dehoust J, Münch M, Seide K, Barth T, Schulz AP, Frosch KH, Hartel MJ. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg 2022; 48:3541-3560. [PMID: 35305114 PMCID: PMC9532317 DOI: 10.1007/s00068-022-01936-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. Methods A systematic literature research was conducted according to the PRISMA guidelines, using the PubMed/MEDLINE and Web of Science databases. 44 studies conducting biomechanical analyses of fixation of acetabular fractures were identified, which met the predefined inclusion and exclusion criteria and which were published in English between 2000 and April 16, 2021. The studies were analyzed with respect to distinct parameters, including fracture type, material of pelvis model, investigated fixation construct, loading direction, loading protocol, maximum loading force, outcome parameter and measurement method. Results In summary, there was no standardized test setup within the studies on fixation constructs for acetabular fractures. It is therefore difficult to compare the studies directly, as they employ a variety of different test parameters. Furthermore, the clinical implications of the biomechanical studies should be scrutinized, since several test parameters were not based on observations of the human physiology. Conclusion The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01936-9.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Klaus Seide
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Tobias Barth
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Arndt-Peter Schulz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Mönkhofer Weg 239 a, 23562, Lübeck, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany. .,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Ye J, Xie L, Liu Z, Lin J, Yan H, Chen Z. Anterograde lag screw placement in the posterior column of the acetabulum: A case report and literature review. Trauma Case Rep 2021; 37:100580. [PMID: 34917743 PMCID: PMC8669443 DOI: 10.1016/j.tcr.2021.100580] [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] [Accepted: 12/06/2021] [Indexed: 10/26/2022] Open
Abstract
Acetabular fractures are complex injuries with an annual incidence of approximately 4 per 100,000 (Laird and Keating, 2005 [1]. Although the open reduction is currently advocated for treating acetabular fractures, some acetabular fractures can be treated by minimally invasive surgery, with the advantages of minor trauma, less bleeding, reduced infection, and shorter operation time. Therefore, we report a case of a patient with a transverse fracture involving the acetabulum treated with a new method of cannulated screw fixation combined with a personalized 3D printed guide to achieving minimally invasive and precise treatment of acetabular fractures while we review the relevant papers.
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Affiliation(s)
- Jialiang Ye
- Department of Orthopaedics, Xiamen, No. 3 Hospital, Xiamen, China
| | - Liangwen Xie
- Department of Orthopaedics, Xiamen, No. 3 Hospital, Xiamen, China
| | - Zhongguo Liu
- Department of Orthopaedics, Xiamen, No. 3 Hospital, Xiamen, China
| | - Jianchun Lin
- Department of Orthopaedics, Xiamen, No. 3 Hospital, Xiamen, China
| | - Hailan Yan
- Surgical Center, Siming Kaiyuan Street Community Health Service Center, Xiamen, China
| | - Zhikun Chen
- Department of Orthopaedics, Xiamen, No. 3 Hospital, Xiamen, China
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Le Quang H, Schmoelz W, Lindtner RA, Dammerer D, Schwendinger P, Krappinger D. Single column plate plus other column lag screw fixation vs. both column plate fixation for anterior column with posterior hemitransverse acetabular fractures - a biomechanical analysis using different loading protocols. Injury 2021; 52:699-704. [PMID: 33454060 DOI: 10.1016/j.injury.2020.12.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Open reduction and internal fixation of both columns is considered the treatment of choice for displaced anterior column with posterior hemitransverse (ACPHT) fractures in non-geriatric patients. Plate fixation of one column combined with lag screw fixation of the other column allows to decrease operative time and approach-related morbidity compared to conventional both column plating. The aim of this biomechanical study was to evaluate whether single column plate plus other column lag screw fixation confers similar stability to both column plate fixation. Physiological loads were simulated using both the single-leg stance (SLS) as well as the sit-to-stand (STS) loading protocols. METHODS A clinically relevant ACPHT fracture model was created using fourth-generation composite hemipelves. Fractures were stabilized with three different fixation constructs: (1) anterior column plate plus posterior column screw fixation (AP+PCS), posterior column plate plus anterior column screw fixation (PP+ACS) and anterior column plate plus posterior column plate fixation (AP+PP). Specimens were loaded from 50 to 750 N with a ramp of 100 N/s. Fracture gap motion (FGM) and relative interfragmentary rotation (RIFR) between the three main fracture fragments were assessed under loads of 750 N using an optical 3D measurement system. RESULTS STS loading generally resulted in higher mean FGM and RIFR than STS loading in the AP+PCS and AP+PP groups, while no significant differences were found in the PP+ACS group. Compared to conventional both column plate fixation (AP+PP), PP+ACS displayed significantly higher FGM and RIFR between the iliac wing and the posterior column during SLS loading. No significant differences in FGM and RIFR were identified between the AP+PCS and the AP+PP group. CONCLUSION Overall, single column plate plus other column lag screw fixation conferred similar stability to conventional both column plate fixation. From a clinical point of view, AP+PCS appears to be the most attractive alternative to conventional AP+PP for internal fixation of ACPHT fractures.
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Affiliation(s)
- Huy Le Quang
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Peter Schwendinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Li Y, Feng R, Liu X, Wang G, Wang W, Lu Q, Huang W, Wu H, Cai X. A Post-Traumatic Osteoarthritic Model of Hip Following Fracture of Acetabulum in Rabbit: A Preliminary Study by Macroscopic and Radiographic Assessment. Orthop Surg 2021; 13:296-305. [PMID: 33398932 PMCID: PMC7862151 DOI: 10.1111/os.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023] Open
Abstract
Objective To develop a post‐traumatic osteoarthritic model of hip following fracture of acetabulum in rabbit for revealing biochemical mechanism of post‐traumatic osteoarthritis. Methods A total of 36 mature male New Zealand white rabbits were equally divided into sham group (n = 12), non‐ORIF group (n = 12), and open reduction and internal fixation (ORIF) group (n = 12). Except for the sham group, rabbits had survival surgeries to create acetabular fractures of dorsal wall for simulating dashboard impaction mechanism. The ORIF group received open reduction and internal fixation, while fractures in the non‐ORIF group were left as displaced but transverse fracture and dislocation was reduced. Besides intraoperative appearance and postoperative recovery, macroscopic and radiographic characteristics of the hips were recorded and assessed by a radiographic scoring scale at 3 weeks, 6 weeks, and 6 months, respectively. Results Out of 24 modeled acetabula, 21 (87.5%) were pure dorsal wall fractures as proposed and the remaining three were associated fractures (dorsal wall plus transverse fracture) accompanied by dorsal dislocation or not. All hips were stable, and no sciatic nerve injury was observed. One rabbit in the ORIF group died of deep infection 4 days after surgery. Rabbits in the sham and ORIF groups returned to normal gait in 2 weeks, but animals in the non‐ORIF group suffered from limping and restricted movement. As the time progressed, the hips in the non‐ORIF group experienced progressive and severe degeneration which exhibited dramatically malformed and hypertrophic joints at 6 months, but the ORIF group maintained much better morphological structure. Corresponding to morphological changes, the average radiographic scores of the non‐ORIF group increased from 1.25 at 3 weeks to 2.75 at 6 months and showed statistically significant difference when compared to the sham group at all three time points (P = 0.011, 0.011, 0.015, respectively, <0.0167). Although the scores of the ORIF group showed apparent improvements (increased from 0.67 at 3 weeks to 2.00 at 6 months), there was no significant difference between the two modeled groups at all three time points. Conclusion The fracture model with high consistency and reproducibility showed progressive post‐traumatic osteoarthritic changes which could be improved by open reduction and internal fixation surgery and provided an alternative selection for investigating potential pathogenesis and pathology of post‐traumatic osteoarthritis following fracture of acetabulum.
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Affiliation(s)
- Yanjin Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Orthopedics, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Ruibing Feng
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Guodong Wang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Wei Wang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Orthopedics, Hubei Province hospital of Traditional Chinese Medicine, Wuhan, China
| | - Qilin Lu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Spine Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, China
| | - Wei Huang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Spine Surgery, Jingmen NO.2 People's Hospital, Jingmen, China
| | - Haiyang Wu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xianhua Cai
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
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