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Erschienen in: European Journal of Trauma and Emergency Surgery 2/2016

17.04.2015 | Original Article

Symphyseal internal rod fixation versus standard plate fixation for open book pelvic ring injuries: a biomechanical study

verfasst von: G. Osterhoff, S. Tiziani, C. Hafner, S. J. Ferguson, H.-P. Simmen, C. M. L. Werner

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2016

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Abstract

Purpose

This study investigates the biomechanical stability of a novel technique for symphyseal internal rod fixation (SYMFIX) using a multiaxial spinal screw-rod implant that allows for direct reduction and can be performed percutaneously and compares it to standard internal plate fixation of the symphysis.

Methods

Standard plate fixation (PLATE, n = 6) and the SYMFIX (n = 6) were tested on pelvic composite models with a simulated open book injury using a universal testing machine. On a previously described testing setup, 500 consecutive cyclic loadings were applied with sinusoidal resulting forces of 200 N. Displacement under loading was measured using an optoelectronic camera system and construct rigidity was calculated as a function of load and displacement.

Results

The rigidity of the PLATE construct was 122.8 N/mm (95 % CI: 110.7–134.8), rigidity of the SYMFIX construct 119.3 N/mm (95 % CI: 105.8–132.7). Displacement in the symphyseal area was mean 0.007 mm (95 % CI: 0.003–0.012) in the PLATE group and 0.021 mm (95 % CI: 0.011–0.031) in the SYMFIX group. Displacement in the sacroiliac joint area was mean 0.156 mm (95 % CI: 0.051–0.261) in the PLATE group and 0.120 mm (95 % CI: 0.039–0.201) in the SYMFIX group.

Conclusions

In comparison to standard internal plate fixation for the stabilization of open book pelvic ring injuries, symphyseal internal rod fixation using a multiaxial spinal screw-rod implant in vitro shows a similar rigidity and comparable low degrees of displacement.
Literatur
1.
Zurück zum Zitat Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329–38.CrossRefPubMedPubMedCentral Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329–38.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.CrossRefPubMed Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.CrossRefPubMed
3.
Zurück zum Zitat Rüedi T, Buckley R, Moran C. AO principles of fracture management, vol. 2. 2nd ed. NewYork: Thieme; 2007. Rüedi T, Buckley R, Moran C. AO principles of fracture management, vol. 2. 2nd ed. NewYork: Thieme; 2007.
4.
Zurück zum Zitat Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg. 1988;70B:1–12. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg. 1988;70B:1–12.
5.
Zurück zum Zitat Putnis SE, Pearce R, Wali UJ, Bircher MD, Rickman MS. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis: one-year radiological and functional outcomes. J Bone Joint Surg Br. 2011;93(1):78–84.CrossRefPubMed Putnis SE, Pearce R, Wali UJ, Bircher MD, Rickman MS. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis: one-year radiological and functional outcomes. J Bone Joint Surg Br. 2011;93(1):78–84.CrossRefPubMed
6.
Zurück zum Zitat Adams MR, Scolaro JA, Routt ML Jr. The pubic midline exposure for symphyseal open reduction and plate fixation. J Orthop Traumatol Off J Italian Soc Orthop Traumatol. 2014;15:195–9.CrossRef Adams MR, Scolaro JA, Routt ML Jr. The pubic midline exposure for symphyseal open reduction and plate fixation. J Orthop Traumatol Off J Italian Soc Orthop Traumatol. 2014;15:195–9.CrossRef
7.
Zurück zum Zitat Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury. 2011;42(10):992–6.CrossRefPubMed Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury. 2011;42(10):992–6.CrossRefPubMed
8.
Zurück zum Zitat Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36(5):599–604.CrossRefPubMed Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36(5):599–604.CrossRefPubMed
9.
Zurück zum Zitat Kuttner M, Klaiber A, Lorenz T, Fuchtmeier B, Neugebauer R. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg. 2009;112(7):661–9.CrossRefPubMed Kuttner M, Klaiber A, Lorenz T, Fuchtmeier B, Neugebauer R. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg. 2009;112(7):661–9.CrossRefPubMed
10.
Zurück zum Zitat Osterhoff G, Tiziani S, Ferguson SJ, Spreiter G, Scheyerer MJ, Spinas GL, Wanner GA, Simmen HP, Werner CM. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation. BMC Musculoskelet Disord. 2014;15:111.CrossRefPubMedPubMedCentral Osterhoff G, Tiziani S, Ferguson SJ, Spreiter G, Scheyerer MJ, Spinas GL, Wanner GA, Simmen HP, Werner CM. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation. BMC Musculoskelet Disord. 2014;15:111.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Scheyerer MJ, Zimmermann SM, Osterhoff G, Tiziani S, Simmen HP, Wanner GA, Werner CM. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes. 2014;7:133.CrossRefPubMedPubMedCentral Scheyerer MJ, Zimmermann SM, Osterhoff G, Tiziani S, Simmen HP, Wanner GA, Werner CM. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes. 2014;7:133.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma. 2012;26(1):1–8.CrossRefPubMed Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma. 2012;26(1):1–8.CrossRefPubMed
13.
Zurück zum Zitat Vaidya R, Kubiak EN, Bergin PF, Dombroski DG, Critchlow RJ, Sethi A, Starr AJ. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012;470(8):2124–31.CrossRefPubMedPubMedCentral Vaidya R, Kubiak EN, Bergin PF, Dombroski DG, Critchlow RJ, Sethi A, Starr AJ. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012;470(8):2124–31.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Ferguson SJ, Winkler F, Nolte LP. Anterior fixation in the osteoporotic spine: cut-out and pullout characteristics of implants. Eur Spine J. 2002;11(6):527–34.CrossRefPubMed Ferguson SJ, Winkler F, Nolte LP. Anterior fixation in the osteoporotic spine: cut-out and pullout characteristics of implants. Eur Spine J. 2002;11(6):527–34.CrossRefPubMed
15.
Zurück zum Zitat Meissner A, Fell M, Wilk R, Boenick U, Rahmanzadeh R. Biomechanics of the pubic symphysis. Which forces lead to mobility of the symphysis in physiological conditions? Unfallchirurg. 1996;99(6):415–21.PubMed Meissner A, Fell M, Wilk R, Boenick U, Rahmanzadeh R. Biomechanics of the pubic symphysis. Which forces lead to mobility of the symphysis in physiological conditions? Unfallchirurg. 1996;99(6):415–21.PubMed
16.
Zurück zum Zitat Clements JP, Moriaty N, Chesser TJ, Ward AJ, Cunningham JL. Determination of pelvic ring stability: a new technique using a composite hemi-pelvis. Proc Inst Mech Eng H. 2008;222(5):611–6.CrossRefPubMed Clements JP, Moriaty N, Chesser TJ, Ward AJ, Cunningham JL. Determination of pelvic ring stability: a new technique using a composite hemi-pelvis. Proc Inst Mech Eng H. 2008;222(5):611–6.CrossRefPubMed
17.
Zurück zum Zitat Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Onwudiwe NA, Vaidya R. Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX) vs External Fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res. 2012;7(1):31.CrossRefPubMedPubMedCentral Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Onwudiwe NA, Vaidya R. Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX) vs External Fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res. 2012;7(1):31.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Vaidya R. Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone. Int Orthop. 2013;37(7):1341–6.CrossRefPubMedPubMedCentral Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Vaidya R. Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone. Int Orthop. 2013;37(7):1341–6.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Dupont WD, Plummer WD. Power and sample size calculations for studies involving linear regression. Control Clin Trials. 1998;19:589–601.CrossRefPubMed Dupont WD, Plummer WD. Power and sample size calculations for studies involving linear regression. Control Clin Trials. 1998;19:589–601.CrossRefPubMed
20.
Zurück zum Zitat Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One. 2013;8(10):e77807.CrossRefPubMedPubMedCentral Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One. 2013;8(10):e77807.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Giraldez-Sanchez MA, Lazaro-Gonzalvez A, Martinez-Reina J, Serrano-Toledano D, Navarro-Robles A, Cano-Luis P, Fragkakis EM, Giannoudis PV. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury. 2014;46:327–32.CrossRefPubMed Giraldez-Sanchez MA, Lazaro-Gonzalvez A, Martinez-Reina J, Serrano-Toledano D, Navarro-Robles A, Cano-Luis P, Fragkakis EM, Giannoudis PV. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury. 2014;46:327–32.CrossRefPubMed
22.
Zurück zum Zitat van Zwienen CM, van den Bosch EW, van Hoek Dijke GA, Snijders CJ, van Vugt AB. Cyclic loading of sacroiliac screws in Tile C pelvic fractures. J Trauma. 2005;58(5):1029–34.CrossRefPubMed van Zwienen CM, van den Bosch EW, van Hoek Dijke GA, Snijders CJ, van Vugt AB. Cyclic loading of sacroiliac screws in Tile C pelvic fractures. J Trauma. 2005;58(5):1029–34.CrossRefPubMed
23.
Zurück zum Zitat Chong AC, Miller F, Buxton M, Friis EA. Fracture toughness and fatigue crack propagation rate of short fiber reinforced epoxy composites for analogue cortical bone. J Biomech Eng. 2007;129(4):487–93.CrossRefPubMed Chong AC, Miller F, Buxton M, Friis EA. Fracture toughness and fatigue crack propagation rate of short fiber reinforced epoxy composites for analogue cortical bone. J Biomech Eng. 2007;129(4):487–93.CrossRefPubMed
24.
Zurück zum Zitat Osterhoff G, Baumgartner D, Favre P, Wanner GA, Gerber H, Simmen HP, Werner CM. Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg. 2011;20(5):740–6.CrossRefPubMed Osterhoff G, Baumgartner D, Favre P, Wanner GA, Gerber H, Simmen HP, Werner CM. Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg. 2011;20(5):740–6.CrossRefPubMed
25.
Zurück zum Zitat Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res. 1996;329:88–96.CrossRefPubMed Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res. 1996;329:88–96.CrossRefPubMed
26.
Zurück zum Zitat Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma. 2008;22(6):373–8.CrossRefPubMed Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma. 2008;22(6):373–8.CrossRefPubMed
27.
Zurück zum Zitat Cappuccio M, Amendola L, Paderni S, Bosco G, Scimeca G, Mirabile L, Gasbarrini A, De Iure F. Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures. Orthopedics. 2013;36(6):e729–34.CrossRefPubMed Cappuccio M, Amendola L, Paderni S, Bosco G, Scimeca G, Mirabile L, Gasbarrini A, De Iure F. Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures. Orthopedics. 2013;36(6):e729–34.CrossRefPubMed
28.
Zurück zum Zitat Ringel F, Stoffel M, Stuer C, Meyer B. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery. 2006;59(4 Suppl 2):ONS361–6 (discussion ONS366–367).PubMed Ringel F, Stoffel M, Stuer C, Meyer B. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery. 2006;59(4 Suppl 2):ONS361–6 (discussion ONS366–367).PubMed
Metadaten
Titel
Symphyseal internal rod fixation versus standard plate fixation for open book pelvic ring injuries: a biomechanical study
verfasst von
G. Osterhoff
S. Tiziani
C. Hafner
S. J. Ferguson
H.-P. Simmen
C. M. L. Werner
Publikationsdatum
17.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 2/2016
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0529-5

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