Tobias Fritz1, Laura Mettelsiefen2, Friedemann Strobel2, Benedikt J Braun3, Steven C Herath4, Sascha J Hopp5, Tina Histing6, Tim Pohlemann7, Antonius Pizanis8. 1. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. Electronic address: tobias.fritz@uks.eu. 2. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. 3. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. Electronic address: benedikt.braun@uks.eu. 4. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. Electronic address: steven.herath@uks.eu. 5. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany; Lutrina Hospital, Kaiserslautern, Karl-Marx-Straße 33, 67655 Kaiserslautern, Germany. Electronic address: sascha.hopp@uks.eu. 6. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. Electronic address: tina.histing@uks.eu. 7. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. Electronic address: tim.pohlemann@uks.eu. 8. Saarland University Medical Center, Department for Trauma, Hand and Reconstructive Surgery, Kirrbergerstr. 1, 66421, Homburg, Saar, Germany. Electronic address: antonius.pizanis@uks.eu.
Abstract
BACKGROUND: Pelvic fractures in adults are common injuries and account for up to 3.64% of all fractures. Usually, the treatment of open book injuries (Types B1.1 and B1.2 AO-Classification) is open reduction and plate stabilization using dynamic compression plates, with or without interlocking screws. These implants seem to enhance the outcome of such injuries, but also variety of complications occurs. To reduce complications and achieve appropriate reduction and stabilization, this study compared established stabilization techniques to a novel minimally invasive internal fixation method using an internal fixator system that is already being utilized for spinal fractures. METHODS: This study was performed on 32 composite pelvises in a bilateral stance biomechanical model. The pelvises were variously stabilized with an internal fixator, a 4.5 mm dynamic compression plate and a 3.5 mm symphyseal locking dynamic compression plate. The contact area and loading forces were assessed by a sensor film inside the symphyseal gap. FINDINGS: This study showed significantly greater reduction and loading capabilities of the internal fixator compared to the other implants (p < 0.05). There was also significantly greater contact area with the use of an internal fixator compared to the other implants (p < 0.05). The 3.5 mm interlocking plate showed significantly greater contact area compared to the 4.5 mm plate (p < 0.05). INTERPRETATION: The internal fixator that is already proven in spinal surgery is biomechanically superior to conventional implants used in pelvic surgery. The contact area analysis furthermore showed a more physiological loading pattern, which can improve ligamentous healing in a clinical context.
BACKGROUND:Pelvic fractures in adults are common injuries and account for up to 3.64% of all fractures. Usually, the treatment of open book injuries (Types B1.1 and B1.2 AO-Classification) is open reduction and plate stabilization using dynamic compression plates, with or without interlocking screws. These implants seem to enhance the outcome of such injuries, but also variety of complications occurs. To reduce complications and achieve appropriate reduction and stabilization, this study compared established stabilization techniques to a novel minimally invasive internal fixation method using an internal fixator system that is already being utilized for spinal fractures. METHODS: This study was performed on 32 composite pelvises in a bilateral stance biomechanical model. The pelvises were variously stabilized with an internal fixator, a 4.5 mm dynamic compression plate and a 3.5 mm symphyseal locking dynamic compression plate. The contact area and loading forces were assessed by a sensor film inside the symphyseal gap. FINDINGS: This study showed significantly greater reduction and loading capabilities of the internal fixator compared to the other implants (p < 0.05). There was also significantly greater contact area with the use of an internal fixator compared to the other implants (p < 0.05). The 3.5 mm interlocking plate showed significantly greater contact area compared to the 4.5 mm plate (p < 0.05). INTERPRETATION: The internal fixator that is already proven in spinal surgery is biomechanically superior to conventional implants used in pelvic surgery. The contact area analysis furthermore showed a more physiological loading pattern, which can improve ligamentous healing in a clinical context.
Authors: Sascha J Hopp; Antonius Pizanis; Jeremy Briem; Jill Hahner; Laura Mettelsiefen; Steven C Herath; Tina Histing; Tim Pohlemann; Tobias Fritz Journal: J Exp Orthop Date: 2020-09-17
Authors: Martin C Jordan; Veronika Jäckle; Sebastian Scheidt; Fabian Gilbert; Stefanie Hölscher-Doht; Süleyman Ergün; Rainer H Meffert; Timo M Heintel Journal: Sci Rep Date: 2021-06-29 Impact factor: 4.379