The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring

Dahill, Mark; McArthur, John; Roberts, GJ; Acharya, Mehool; Ward, Anthony J. I.; Chesser, T.J.S.

doi:10.1302/0301-620x.99b9.bjj-2016-1025.r2

Cited by 33 publications

(34 citation statements)

References 14 publications

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“…ISS has become a commonly used technology in the treatment of pelvic posterior ring disruption. However, the ISS technique requires great surgical skill and continuous fluoroscopic guidance for appropriate screw insertion, and the risk of neurovascular injuries has been demonstrated to be higher than that for other techniques. A tension band plate placed in the posterior pelvic ring can provide sufficient stability for Tile C fractures.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Wang

et al. 2019

Orthopaedic Surgery

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Objective To compare the biomechanical stability and compatibility of two iliosacral screws (ISS), a tension band plate (TBP), and a minimally invasive adjustable plate (MIAP) for treating Tile C pelvic fractures. Methods Three groups of finite element models of the intact pelvis, including the main ligament and the proximal one‐third of both femurs, were developed to simulate vertical sacral fractures and treated with the three abovementioned internal fixation techniques. A 500 N vertical load, a 500 N vertical load plus a 10 Nm moment of forward sagittal direction, and 500 N vertical load plus a 10 Nm moment of right lateral direction were applied to the sacrum to simulate standing status, bending status, and flexion status, respectively. The maximum displacement value, the stress value, and the stress value of the fracture interface were compared among the three internal fixation techniques. Results The results showed that all three internal fixation techniques effectively restored the biomechanical transmission of the injured pelvis. The stress on the implants in the TBP model was 167.47% and 53.41% higher than that in the ISS model and the MIAP model, respectively, and the stress shielding phenomenon of the TBP model was more obvious than in the other two models. Meanwhile, the stress between the fracture interfaces in the TBP fixation models was apparently higher than that in the other two models. However, the vertical displacement of the MIAP model was not significantly different from that in the ISS and TBP model; therefore, strong fixation could be obtained in all three models. Conclusion Based on our results, we believe that the stability of Tile C pelvic fracture fixed with MIAP was similar to that of fractures fixed with ISS and TBP, but the stress shielding phenomenon and safety of implants in the TBP models were inferior to those in the MIAP and ISS fixation models. Meanwhile, MIAP and ISS fixation were more helpful to the healing processing than was TBP fixation, especially at the fracture interface of the second and third vertebral body levels.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Wang

et al. 2019

Orthopaedic Surgery

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“…Most surgeons agree that external fixation is not the definitive treatment for pelvic anterior ring injuries, except in some special cases, and that internal fixation should be the priority. [ 1 , 3 , 6 , 12 , 14 , 18 ] Currently, there are 3 primary types of internal fixation used to treat pelvic anterior ring injuries, an internal fixator (INFIX), a reconstruction plate, and a cannulated screw. All 3 can be inserted with this minimally invasive technique.…”

Section: Discussionmentioning

confidence: 99%

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Sun

Yan

Wang³

et al. 2020

Medicine

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The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation. We retrospectively reviewed 18 patients (aged 25–62, 34.2 ± 7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ± 3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed. The operation time ranged from 30 to 65 minutes (42.8 ± 18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ± 22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ± 4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ± 2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation. Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.

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“…The analysis of the different types of anterior fixation showed that the likelihood of complications increases with the invasiveness of the stabilizing surgery. However, the categories given by the register do not allow to be very specific about biomechanical stability, which can be decisive 21,22 . Whether computer models based on finite element calculation methods will provide a reliable prediction method to calculate sufficiency of different stabilization techniques in individual patients, considering fracture morphology and bone quality, needs to be determined 23 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of strategies for the treatment of type B and C pelvic fractures

Schmal

Froberg

Larsen

et al. 2018

The Bone & Joint Journal

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The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring

Abstract: The anterior pelvic internal fixator reduces the need for extensive open surgery and is a useful addition to the armamentarium for the treatment of anterior pelvic injuries. It is associated with injury to the LFCN in a third of patients. Cite this article: 2017;99-B.1232-6.

Cited by 33 publications

References 14 publications

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Evaluation of strategies for the treatment of type B and C pelvic fractures

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