Techniques for Final Pelvic Ring Fixation Based on the Method of Finite Element Modeling

Донченко, С. В.; Дубров, В.Э.; Голубятников, А.В.; Cherniaev, A.; Kuz’kin, I. A; Алексеев, Д. В.; Лебедев, А.Ф.

doi:10.32414/0869-8678-2014-1-38-44

Cited by 4 publications

(1 citation statement)

References 13 publications

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“…1). ственной травмы, что утяжеляет общее состояние пострадавшего и усложняет лечение сочетанных повреждений, особенно на этапе реанимации, где по правилам damage control требуется неотложная стабилизация тазового кольца в рамках противошоковых мероприятий [10,11]. у пожилых пациентов чаще диагностируются изолированные переломы лонных костей.…”

Section: Introductionunclassified

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Иванов

Заднепровский

Nevedrov

et al. 2018

Traumatology and Orthopedics of Russia

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Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy.

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Section: Introductionunclassified

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Иванов

Заднепровский

Nevedrov

et al. 2018

Traumatology and Orthopedics of Russia

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Potentialities of low invasive fixation of the anterior pelvic ring with threaded pin

Solod

Lazarev

Petrovskiy

et al. 2018

N.N. Priorov Journal of Traumatology and Orthopedics

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2 Городская клиническая больница им. А.К. Ерамишанцева, Москва, РФ; 3 ФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава России, Москва, РФ; 4 ГБУЗ КО «Калужская областная клиническая больница скорой медицинской помощи им. К.Н. Шевченко», Калуга, Россия Цель исследования: представить первый опыт использования способа фиксации переломов лонных костей с помощью спиц с нарезкой и возможности его применения в практике.

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Biomechanical Modeling of Options for Internal Fixation of Unilateral Fractures of the Sacrum

Кажанов

Микитюк

Dol

et al. 2020

Traumatology and Orthopedics of Russia

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Relevance. Currently, the stability of various options for the fixation of sacral fractures by the finite element method has not been sufficiently studied.Purpose — the biomechanical characteristics of two variants of internal fixation of unilateral sacral fractures by various implants and the localization of the line of its fracture with respect to the articular facet of the L5-S1 vertebrae were studied.Materials and Methods. Using the finite element method, we studied the biomechanical characteristics of two options for fixing a one-sided longitudinal fracture of the sacrum with different localization of the line of its fracture: outside, inside and directly on the joint facet L5-S1. Two fixation options are considered: cannulated sacroiliac screws and a similar option in combination with a bilateral lumbar-pelvic transpedicular system.Results. The stresses in implants and bone under compression load and torso forward or backward are almost the same in all models. In the model of fixation with a sacroiliac screw of a one-sided longitudinal sacral fracture, the line of which passes through the articular process S1 of the vertebra (Isler II type), the greatest stress in the screws under compression load and bending moment was 619.7 MPa, which exceeds the yield strength of the titanium alloy and can damage the implants. In all models where the transpedicular system additionally acted as fixing structures, a decrease of 42–77% of maximum displacements was noted, by 28–79% of equivalent stresses in implants under all types of loads, while the equivalent stresses in the bone structures did not differ significantly. In models where the transpedicular system was additionally applied, a decrease of 42–77% of maximum displacements was noted, by 28-79% of stresses in implants under all types of loads, while the stresses in the bones did not differ much.Conclusion. In all cases of localization of the line of unilateral fracture of the sacrum, the use of a transpedicular system in combination with sacroiliac screws is more stable from the point of view of biomechanics. The most unstable is a one-sided longitudinal fracture of the sacrum passing through the facet L5-S1.

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Techniques for Final Pelvic Ring Fixation Based on the Method of Finite Element Modeling

Cited by 4 publications

References 13 publications

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Potentialities of low invasive fixation of the anterior pelvic ring with threaded pin

Biomechanical Modeling of Options for Internal Fixation of Unilateral Fractures of the Sacrum

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