Development of a Patient-Specific Finite Element Model for Predicting Implant Failure in Pelvic Ring Fracture Fixation

Introduction. The main purpose of this study is to develop an efficient technique for generating FE models of pelvic ring fractures that is capable of predicting possible failure regions of osteosynthesis with acceptable accuracy. Methods. Patient-specific FE models of two patients with osteoporotic pelvic fractures were generated. A validated FE model of an uninjured pelvis from our previous study was used as a master model. Then, fracture morphologies and implant positions defined by a trauma surgeon in the preoperative CT were manually introduced as 3D splines to the master model. Four loading cases were used as boundary conditions. Regions of high stresses in the models were compared with actual locations of implant breakages and loosening identified from follow-up X-rays. Results. Model predictions and the actual clinical outcomes matched well. For Patient A, zones of increased tension and maximum stress coincided well with the actual locations of implant loosening. For Patient B, the model predicted accurately the loosening of the implant in the anterior region. Conclusion. Since a significant reduction in time and labour was achieved in our mesh generation technique, it can be considered as a viable option to be implemented as a part of the clinical routine to aid presurgical planning and postsurgical management of pelvic ring fracture patients.

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Corrigendum to “Development of a Patient-Specific Finite Element Model for Predicting Implant Failure in Pelvic Ring Fracture Fixation”

Computational and Mathematical Methods in Medicine ◽

10.1155/2017/8956549 ◽

2017 ◽

Vol 2017 ◽

pp. 1-1

Author(s):

Vickie Shim ◽

Andreas Gather ◽

Andreas Höch ◽

David Schreiber ◽

Ronny Grunert ◽

...

Keyword(s):

Finite Element ◽

Finite Element Model ◽

Fracture Fixation ◽

Pelvic Ring ◽

Element Model ◽

Implant Failure ◽

Pelvic Ring Fracture ◽

Patient Specific ◽

Ring Fracture

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The Combination of Intraoperative CT Navigation and C-arm Fluoroscopy for INFIX and Percutaneous TITS Screw Placement in the Treatment of Pelvic Ring Injury: Technical Note

10.21203/rs.3.rs-749457/v1 ◽

2021 ◽

Author(s):

Akihiko Hiyama ◽

Taku Ukai ◽

Satoshi Nomura ◽

Masahiko Watanabe

Keyword(s):

Radiation Exposure ◽

Pelvic Ring ◽

Technical Note ◽

Pelvic Ring Fracture ◽

X Rays ◽

Ring Fracture ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Screw Insertion ◽

Rod System

Abstract BACKGROUND: The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture.METHODS: Here is a typical case. An 86-year-old woman suffered an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation was selected to optimize surgical invasiveness and proper implant placement.RESULTS: The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon.　Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. CONCLUSIONS: The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

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The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-022-02920-0 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Akihiko Hiyama ◽

Taku Ukai ◽

Satoshi Nomura ◽

Masahiko Watanabe

Keyword(s):

Radiation Exposure ◽

Pelvic Ring ◽

Technical Note ◽

Pelvic Ring Fracture ◽

X Rays ◽

Ring Fracture ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Screw Insertion ◽

Rod System

Abstract Background The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture. Methods A typical case is presented in this study. An 86-year-old woman suffered from an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation were selected to optimize surgical invasiveness and proper implant placement. Results The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon. Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. Conclusions The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

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Less invasive lumbopelvic fixation technique using a percutaneous pedicle screw system for unstable pelvic ring fracture in a patient with severe multiple traumas

Journal of Neurosurgery Spine ◽

10.3171/2016.7.spine16323 ◽

2017 ◽

Vol 26 (2) ◽

pp. 203-207 ◽

Cited By ~ 6

Author(s):

Sei Yano ◽

Yasuchika Aoki ◽

Atsuya Watanabe ◽

Takayuki Nakajima ◽

Makoto Takazawa ◽

...

Keyword(s):

Pelvic Ring ◽

Spinous Process ◽

Pelvic Ring Fracture ◽

Fixation Technique ◽

Multiple Fractures ◽

Ring Fracture ◽

Less Invasive ◽

Pelvic Ring Fractures ◽

Iliac Screws ◽

Multiple Traumas

Pelvic ring fractures are defined as life-threatening injuries that can be treated surgically with external or internal fixation. The authors report on an 81-year-old woman with an unstable pelvic fracture accompanying multiple traumas that was successfully treated with a less invasive procedure. The patient was injured in a traffic accident and sustained a total of 20 fractures, including pelvic ring, bilateral rib, and lumbar transverse processes fractures, and multiple fractures of both upper and lower extremities. The pelvic ring fracture was unstable with fractures of the bilateral sacrum with right sacroiliac disruption, right superior and inferior pubic rami, left superior pubic ramus, and ischium. During emergency surgery, bilateral external fixation was applied to the iliac crest to stabilize the pelvic ring. Second and third surgeries were performed 11 and 18 days after the first emergency surgery, respectively, to treat the multiple fractures. At the third surgery, the pelvic ring fracture was stabilized surgically using a less invasive posterior fixation technique. In this technique, 2 iliac screws were inserted on each side following an 8-cm midline posterior incision from the S-1 to S-3 spinous process, with the subcutaneous tissue detached from the fascia of the paraspinal muscles. The S-2 spinous process was removed and 2 rods were connected to bilateral iliac screws to stabilize the bilateral ilium in a switchback fashion. A crosslink device was applied to connect the 2 rods at the base of the S-2 spinous process. Following pelvic fixation, percutaneous pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides, and connected to the cranial rod connecting the bilateral iliac screws, thus completing the lumbopelvic fixation. The postoperative course was favorable with no postoperative complications. At the 10-month follow-up, bone union had been achieved at the superior ramus of the pubis, the patient did not complain of pain, and her activities of daily life returned to preinjury status. Unstable pelvic ring fractures need to be sufficiently stabilized for good surgical outcome. However, to avoid postoperative complications, a less invasive treatment is preferred, particularly in cases with poor general condition. This procedure is less invasive and provides sufficient stabilization to the unstable pelvic ring fracture, and thus is the ideal surgical procedure for such cases.

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Acute renal failure and paraplegia in a patient with a pelvic‐ring fracture

Nephrology Dialysis Transplantation ◽

10.1093/ndt/15.12.2050 ◽

2000 ◽

Vol 15 (12) ◽

pp. 2050-2052 ◽

Cited By ~ 2

Author(s):

Rita Rachmani ◽

Zohar Levi ◽

Rivka Zissin ◽

Jacques Bernheim ◽

Ze'ev Korzets

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Pelvic Ring ◽

Pelvic Ring Fracture ◽

Ring Fracture

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Effects of minimally invasive plate-screw internal fixation in the treatment of posterior pelvic ring fracture

Experimental and Therapeutic Medicine ◽

10.3892/etm.2018.6670 ◽

2018 ◽

Cited By ~ 2

Author(s):

Shiguang Li ◽

Xianxia Meng ◽

Wenlong Li ◽

Zhaoyun Sun ◽

Xing Wang ◽

...

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Pelvic Ring ◽

Pelvic Ring Fracture ◽

Ring Fracture ◽

Posterior Pelvic Ring

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Lumbopelvic Stabilisation in Patients Over 50 with Posterior Pelvic Ring Fracture

Orthopedics and Rheumatology Open Access Journal ◽

10.19080/oroaj.2016.02.555586 ◽

2016 ◽

Vol 2 (3) ◽

Cited By ~ 2

Author(s):

Florian Hess

Keyword(s):

Pelvic Ring ◽

Pelvic Ring Fracture ◽

Ring Fracture ◽

Posterior Pelvic Ring

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The prevalance of femoroacetabular impingement findings on radiological survey of the emergeny service patients with trauma

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00066 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0006

Author(s):

Gökhan Polat ◽

Koray Şahin ◽

Ufuk Arzu ◽

Mehmet Aşık

Keyword(s):

Emergency Service ◽

Pelvic Ring ◽

Adult Population ◽

Alpha Angle ◽

Symphysis Pubis ◽

Lower Limbs ◽

Female Group ◽

X Rays ◽

Pelvic Ring Fractures ◽

Asymptomatic Stage

Femoroacetabular impingemet (FAI) is a disease causing hip pain in young-adult population and can be diagnosed frequently on asymptomatic stage. The European studies on this subject show that 20-25% of the population actually has asymptomatic FAI. Actually, there is no study in Turkey on this topic. The purpose of our study is to determine the prevalance of FAI on the X-rays of the patients who applied to the emergency service with trauma. Materials-Methods: Patients applied between September 2015 and January 2016 aged 18-65 and who has pelvis AP and frog leg X-rays were included. Pelvic graphs on which both iliac crests and proximal femurs are seen, the X-ray tube is centralised to the symphysis pubis and the obturator foramens are symmetrical were included. The graphs with fractures or ligamentous injuries affecting the pelvic ring, fractures on long bones of the lower limbs, arthrosis on coxofemoral joint and findings of previous pelvic and hip surgery were excluded. Totally 3487 patients were evaluated and 528 of them were included. Alpha, lateral central edge (LCE), Tönnis and collodiaphyseal angle were measured. The morphological anomalies (FAI, dysplasia) were noted. The measured alpha angle value above 55° graphs were accepted as CAM type; Tönnis angle below 4° angle or LCE angle above 39° were accepted as Pincer type impingement. The graphs with LCE angle below 25° or with Tönnis angle above 10° were considered as dysplasia. Results: The average age of the 528 included patients was 43,38. 323 were female and 205 were male. We determined 15,5% CAM, 11,1% Pincer and 4,7% combined type FAI in these 528 patients.The ratios were noted in female group, 4,6% CAM, 13,3% Pincer and 1,5% combined type; in male group 32,7% CAM, 7,8% Pincer 9,8% combined type. Average alpha angle on pelvis AP graphs was 48,9° on right and 47,8° on left side. Average alpha angle on pelvis frog leg graphs was 51,7° on right, 49,8° on left side. Average LCE angle was 32,9° on right and 34,7° on left side. Average Tönnis angle was 6,7° for right and 5,8° for left side. SPSS.21 were used to analyse the data. Discussion: FAI can be seen in population asymptomatically with a seriously high rates. In our study, we evaluated the asypmtomatic patients with trauma applying to the emergency service and we found radiological FAI findings rate 19,5% in females and 50,2% in males.

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