The morphological mapping of lateral compression type 1 pelvic fracture and pelvic ring stability classification: a finite element analysis

Abstract

Purpose This finite element analysis assessed lateral compression (LC-1) fracture stability using machine learning for morphological mapping and classification of pelvic ring stability. Methods Computed tomography (CT) files of LC-1 pelvic fractures were collected. After morphological mapping and producing matrix data, we used K-means clustering in unsupervised machine learning to classify the fractures. Based on these subtypes, we manually added fracture lines in ANSYS software. Finally, we performed a finite element analysis of a normal pelvis and eight fracture subtypes based on von Mises stress and total deformation changes. Results A total of 218 consecutive cases were analyzed. According to the three main factors—zone of sacral injury and completion, pubic ramus injury side, and the sagittal rotation of the injured hemipelvis—the LC-1 injuries were classified into eight subtypes (I–VIII). No significant differences in stress or deformation were observed between unilateral and bilateral public ramus fractures. Subtypes VI and VIII showed the maximum stress while subtypes V–VIII showed the maximum deformation in the total pelvis and sacrum. The subtypes did not differ in superior public ramus deformation. Conclusions Complete fracture of sacrum zones 2/3 may be a feature of unstable LC-1 fractures. Surgeons should give surgical strategies for subtypes V–VIII.

Operative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries: Analysis of Outcomes Before and After Implementation of a Departmental Stress Protocol

“…2,[7][8][9][10][11][12][13][14][15][16][17][18][19] To better identify patients who may benefit from surgical fixation, many studies have investigated injury patterns and characteristics suggestive of instability. 2,10,[20][21][22][23] In addition, examination under anesthesia (EUA) and stress radiographs have been used in evaluation of patients with minimally displaced injuries to determine the degree of dynamic displacement present to identify patients who may benefit from operative management. 5,6,12,18,[24][25][26][27][28][29] With the reported advantages of reduced resource utilization, normalized force application, and standardized measurements, lateral stress radiographs (LSRs) have been routinely applied for the evaluation of minimally displaced LC1 injuries at our level 1 trauma center to guide management recommendations.…”

“…2,7–19 To better identify patients who may benefit from surgical fixation, many studies have investigated injury patterns and characteristics suggestive of instability. 2,10,20–23 In addition, examination under anesthesia (EUA) and stress radiographs have been used in evaluation of patients with minimally displaced injuries to determine the degree of dynamic displacement present to identify patients who may benefit from operative management. 5,6,12,18,24–29…”