Minimally invasive screw fixation is as stable as anterior plating in acetabular T-Type fractures – a biomechanical study

Becker, C.; Kammerlander, Christian; Kußmaul, Adrian Cavalcanti; Dotzauer, Fabian; Woiczinski, Matthias; Rubenbauer, Bianka; Sommer, Fabian; Linhart, Christoph; Weidert, Simon; Zeckey, Christian; Greiner, Andreas

doi:10.1016/j.otsr.2018.06.013

Cited by 19 publications

(21 citation statements)

References 27 publications

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“…With the Smith-Petersen approach, the femoral head can be exposed directly with Figure 4 position (abduction and external rotation) of the affected hip, without dislocation of the femoral head. Anterior plating fixation in transverse or T-type fracture was performed based on Becker's biomechanical study [ 29 ]. They compared minimally invasive screw fixation and anterior plating in the treatment of acetabular T-type fractures.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Posterior Dislocation of Hip Combined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques

Hung

Chou

et al. 2019

BioMed Research International

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Background and Purpose. Hip dislocation combined with acetabular fracture remains a challenging condition for orthopedic surgeons. In this study, we utilized a computer-assisted simulation and three-dimensional (3D) printing technology to treat patients with hip dislocation combined with acetabular fracture. We hypothesized that the 3D printing-assisted method would shorten the internal fixation time and surgical time. Methods. We retrospectively reviewed 16 patients diagnosed with traumatic posterior dislocation of hip combined with acetabular fractures and treated with plate fixation from September 2013 to August 2017. Patients were divided into two groups: (1) traditional method and (2) 3D printing groups. In the traditional method group, the plates were contoured during the surgery, whereas in the 3D printing group, the patient’s pelvic computed tomography image was transformed to the 3D medical image software for processing preoperatively. The fracture reduction was simulated by the computer. Thereafter, the 1:1 scale 3D printing model was used to design the surgical plan and contour patient-specific plates preoperatively. Results. The internal fixation time was significantly shorter in the 3D printing group than in the traditional method group (-33 min, P<0.05). The mean operative time was shorter than that in the traditional method group (-43 min). However, blood loss and postoperative radiograph results were similar between the groups. The complication rate was lower in the 3D printing group (2/7) than in the traditional method group (5/9). Interpretation. Computer-assisted simulation with 3D printing technology is a more efficient method for treating hip dislocation combined with acetabular fractures.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Posterior Dislocation of Hip Combined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques

Hung

Chou

et al. 2019

BioMed Research International

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“…Based on previous research [ 20 , 21 ], the parameters displacement (mm) and stiffness (N/mm) were used to compare the biomechanical properties of the different fixation techniques.…”

Section: Methodsmentioning

confidence: 99%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Kußmaul

Schwaabe

Kistler³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge™) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. Materials and methods Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge™ in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. Results Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge™ techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). Conclusions Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge™ as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior.

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“…The most frequently investigated fracture types in biomechanical tests as well as in FEA were an ACPHT fracture (biomechanical tests: 11; FEA: 3) [ 36 – 44 , 60 , 63 , 66 , 71 ], a posterior column/wall fracture (biomechanical tests: 9; FEA: 2) [ 52 – 59 , 62 , 67 ], and a transverse acetabular fracture (biomechanical tests: 7; FEA: 2) [ 28 – 34 , 70 ]. Other fracture types (associated both column fracture, T-shape fracture and isolated anterior column fracture) were less frequently studied in biomechanical analyses [ 35 , 45 – 51 , 61 , 64 , 65 , 68 – 70 ]. The numbers of investigated fracture types within the reported studies are demonstrated in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…For biomechanical tests, research groups could choose between human cadaveric pelves prepared in various ways, or synthetic pelvis models, which consisted of bone substitutes intended to reflect the biomechanics of physiological bone. Most research groups investigating fixation methods for acetabular fractures used synthetic pelves models (25 test setups) [ 28 – 32 , 35 – 44 , 49 – 51 , 54 – 56 , 60 – 63 ]. These models consisted of a whole pelvis or a hemipelvis model fixed in different ways to enable particular loading directions.…”

Section: Resultsmentioning

confidence: 99%

“…THAs were mostly analyzed in studies dealing with posterior wall fractures, transverse fractures and ACPHT fractures. A few studies investigated other fixation methods: cable/wire fixation [ 34 , 63 ], a subcutaneous internal anterior fixation [ 35 ], an acetabular fracture reduction internal fixator [ 43 ], an acetabular tridimensional memory alloy-fixation system [ 58 ] or calcium phosphate cement [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

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Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups

Hinz

Dehoust

Münch

et al. 2022

Eur J Trauma Emerg Surg

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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.

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Minimally invasive screw fixation is as stable as anterior plating in acetabular T-Type fractures – a biomechanical study

Abstract: III, case control prospective experimental study.

Cited by 19 publications

References 27 publications

Surgical Treatment for Posterior Dislocation of Hip Combined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques

Surgical Treatment for Posterior Dislocation of Hip Combined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups

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