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Biomechanical comparison of minimally invasive treatment options for Type C unstable fractures of the pelvic ring - 30/01/20

Doi : 10.1016/j.otsr.2019.09.032 
Adrian Cavalcanti Kußmaul a, Axel Greiner a, Christian Kammerlander a, Christian Zeckey a, Matthias Woiczinski b, Christoph Thorwächter b, Clara Gennen a, Christian Kleber c, Wolfgang Böcker a, Christopher A. Becker a,
a Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany 
b Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany 
c University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Technische Universität, Fetscherstr. 74, 01307 Dresden, Germany 

Corresponding author. Department of General Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.Department of General Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr.15Munich81377Germany

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Abstract

Background

The definite treatment of pelvic C fractures presents a widely discussed issue and undergoes continuous evolution. While the stabilization of the posterior ring has been studied extensively, the fixation of the anterior pelvic ring continuous to be rarely investigated. The importance of the simultaneous stabilization however lays in the earlier mobilization and prevention of long-term damage to the pelvis. Therefore we investigated four combinations of minimally invasive fixation techniques for unstable type C1-3 pelvic injuries and aimed to answer the following research questions: (1) what combination of fixation methods yields the highest stiffness and the least displacement? (2) Is the combination of a single sacroiliac screw (SI-screw) with a transiliac internal fixator (TIFI) a reasonable alternative to two SI-screws? (3) Is a modified unilateral anterior fixation comparable to a retrograde transpubic screw?

Hypothesis

Minimally invasive fixation techniques provide sufficient biomechanical stability for type C pelvic fractures.

Methods

Thirty synthetic full pelvises were divided into 5 groups, of which 4 groups were assigned a different osteosynthesis method and one was an intact pelvis used as reference (group 1: internal fixator+2 sacroiliac screws, group 2: internal fixator+transiliac internal fixator+1 sacroiliac screw, group 3: retrograde transpubic screw+2 sacroiliac screws, group 4: retrograde transpubic screw+transiliac internal fixator+1 sacroiliac screw). The pelvises underwent a protocol of cyclic loading between 100N and 200N, during which they were subjected to compression loads while the position of the fracture fragments was measured every 30 milliseconds. Displacement and stiffness were calculated for statistical analysis.

Results

The minimally invasive fixation methods investigated in this study all provide sufficient biomechanical stability without one method being superior to the others (p [anterior displacement]=0.61 and p [posterior displacement]=0.88). Group 3 was allowed the least displacement (1.8±0.2mm for anterior and posterior fracture) for the treatment of a C1.3 fracture. The other fixation methods displayed the following dislocations (mm) of the anterior pelvic ring: group 1: 1.9±0.3, group 2: 2.1±0.4, group 4: 2.0±0.5. Posteriorly, the displacements (mm) were the following: group 1: 1.8±0.6, group 2: 1.9±0.2, group 4: 2.0±0.5.

Discussion

The minimally invasive fixation methods investigated in this study all provide sufficient biomechanical stability without one method being superior to the others since differences were not significant regarding anterior and posterior displacements. Even if not significantly, we could reveal that out of all the methods tested the combination of 2 SI-screws with a retrograde transpubic screw (group 3) displayed the least displacement and highest stiffness. These techniques could therefore potentially improve patient's clinical outcome by reducing the surgical invasiveness and procedure time while providing sufficient biomechanical stability.

Level of evidence

III, comparative in vitro study.

El texto completo de este artículo está disponible en PDF.

Keywords : Unstable pelvic ring fracture, Biomechanics, Trauma, Minimally invasive osteosynthesis


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Vol 106 - N° 1

P. 127-133 - février 2020 Regresar al número
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