scholarly journals Applicable safety analysis and biomechanical study of iliosacral triangular osteosynthesis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jianxiong Zheng ◽  
Jie Xiang ◽  
Xiaoreng Feng ◽  
Fei Liu ◽  
Keyu Chen ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Relative Displacement ◽  
Biomechanical Study ◽  
Fe Model ◽  
Imaging Data ◽  
Biomechanical Stability ◽  
Posterior Pelvic Ring ◽  
Sacroiliac Screw ◽  
Triangular Osteosynthesis ◽  
Loading Methods

Abstract Background The aim of this study was to investigate the applicable safety and biomechanical stability of iliosacral triangular osteosynthesis (ITO) through 3D modeling and finite element (FE) analysis. Methods Pelvic CT imaging data from 100 cases were imported into Mimics software for the construction of 3D pelvic models. The S2-alar-iliac (S2AI) screws and S2 sacroiliac screws were placed in the S2 segment with optimal distribution and their compatibility rate on the S2 safe channel was observed and analyzed. In the FE model, the posterior pelvic ring was fixed with two transsacral screws (TTS), triangular osteosynthesis (TO) and ITO, respectively. Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending, and left twisting, respectively. The relative displacement and change in relative displacement of the three fixing methods were recorded and analyzed. Results The theoretical compatibility rate of S2AI screw and S2 sacroiliac screw in S2 segment was 94%, of which 100% were in males and 88% in females. In the FE model, in terms of overall relative displacement, TTS group showed the smallest relative displacement, the ITO group showed the second smallest, and the TO group the largest relative displacement. The change in relative displacement of the TTS group displayed the smaller fluctuations in motion. The change in relative displacement of the TO group under right bending and left twisting displayed larger fluctuations, while the ITO group under flexion displayed larger fluctuations. Conclusions The simultaneous placement of S2AI screw and S2 sacroiliac screw in the S2 segment is theoretically safe. Although the biomechanical stability of ITO is slightly lower than TTS, it is better than TO, and can be used as a new method for the treatment of posterior pelvic ring injuries.

scholarly journals Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method

2021 ◽  
Vol 10 (2) ◽  
pp. 184
Author(s):  
Maximilian Kerschbaum ◽  
Siegmund Lang ◽  
Florian Baumann ◽  
Volker Alt ◽  
Michael Worlicek
Keyword(s):  
Pelvic Ring ◽  
Three Dimensional ◽  
Fusion Method ◽  
Two Dimensional ◽  
Posterior Pelvic Ring ◽  
Simple Method ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Multiplanar Reconstructions ◽  
Screw Position

Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.

scholarly journals Tape suture for stabilization of incomplete posterior pelvic ring fractures—biomechanical analysis of a new minimally invasive treatment for incomplete lateral compression pelvic ring fractures

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Christopher Alexander Becker ◽  
Adrian Cavalcanti Kussmaul ◽  
Eduardo Manuel Suero ◽  
Markus Regauer ◽  
Matthias Woiczinski ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Tracking System ◽  
Fracture Site ◽  
Biomechanical Analysis ◽  
Lateral Compression ◽  
Posterior Pelvic Ring ◽  
Sacroiliac Screw ◽  
Minimal Invasiveness ◽  
Compression Fractures ◽  
Pelvic Ring Fractures

Abstract Background Incomplete lateral compression fractures (including AO Type B2.1) are among the most common pelvic ring injuries. Although the treatment of choice remains controversial, sacroiliac (SI) screws are commonly used for the operative treatment of incomplete lateral compression fractures of the pelvic ring. However, the disadvantages of SI screws include the risk of nerve root or blood vessel injury. Recently, tape sutures have been found useful as stabilizing material for the treatment of injuries of the syndesmosis, the rotator cuff and knee ligaments. In this current study, we aimed to test the biomechanical feasibility of tape sutures to stabilize the pelvis in the setting of AO Type B2.1 injury. Methods Six human cadaveric pelvises underwent cyclic loading to compare the biomechanical stability of different osteosynthesis methods in a B2.1 fracture model. The methods tested in this experiment were a FiberTape® suture and the currently established SI screw. A 3D ultrasound tracking system was used to measure fracture fragment motion. Linear regression was used to model displacement and stiffness at the posterior and anterior pelvic ring. Results At the posterior fracture site, the FiberTape® demonstrated similar displacement (2.2 ± 0.8 mm) and stiffness (52.2 ± 18.0 N/mm) compared to the sacroiliac screw (displacement 2.1 ± 0.6 mm, P >  0.999; stiffness 50.8 ± 13.0 N/mm, P > 0.999). Considering the anterior fracture site, the FiberTape® again demonstrated similar displacement (3.8 ± 1.3 mm) and stiffness (29.5 ± 9.0 N/mm) compared to the sacroiliac screw (displacement 2.9 ± 0.8 mm, P = 0.2196; stiffness 37.5 ± 11.5 N/mm, P = 0.0711). Conclusion The newly presented osteosynthesis, the FiberTape®, shows promising results for the stabilization of the posterior pelvic ring in AO Type B2.1 lateral compression fractures compared to a sacroiliac screw osteosynthesis based on its minimal-invasiveness and the statistically similar biomechanical properties.

COMPARISON OF X-RAY AND CT METHODS FOR ASSESSING SACRAL SHAPE VARIANTS AND IDENTIFYING A SECURE SACROILIAC SCREW FIXATION CORRIDOR

2019 ◽  
Vol 22 (03n04) ◽  
pp. 1950007
Author(s):  
Florian Radetzki ◽  
Felix Goehre ◽  
Stefan Schwan ◽  
Andreas Wienke ◽  
Lars Jansch ◽  
...  
Keyword(s):  
Predictive Value ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Invasive Technique ◽  
Posterior Pelvic Ring ◽  
Predictive Values ◽  
X Ray ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Sacroiliac Screw Fixation

Sacroiliac screw fixation is the only minimally invasive technique for stabilizing unstable posterior pelvic ring fractures. X-ray/CT methods identify sacral shape variants, which influence screw fixation feasibility at sacral segment S1. As no reliability analysis was previously published, this study analyzed four X-ray/CT-based screw corridor evaluation methods. CT datasets of 80 human pelvises (♂[Formula: see text][Formula: see text], ♀[Formula: see text][Formula: see text], [Formula: see text] years, [Formula: see text][Formula: see text]cm, [Formula: see text][Formula: see text]kg) were used. CTs were post-processed using Amira 5.2 software to generate 3D models and analyzed for S1 transverse 7.3[Formula: see text]mm screw corridors using a C++ program. CT-slices and radiograph-like images were generated per each classification’s requirements. Five surgeons independently assessed sacral shape and transverse screw insertion feasibility. Sensitivity, specificity, and positive/negative predictive values were calculated. C++ analysis indicated feasible screw insertion in 66 cases (82%). Sensitivities were 86% (Mendel), 75% (Routt), 74% (Carlson), and 67% (Kim). Specificities were 73% (Mendel) and 79% (Kim). Mean positive predictive value spanned from 54.6% (Mendel) to 26.2% (Carlson); negative predictive value spanned from 94.5% (Kim) to 90.4% (Carlson). No significant differences existed between surgeons. Mendel’s classification provides reliable and reproducible assessment via the lateral sacral triangle, without additional CTs like Carlson or Routt or the subjectivity of Kim’s method.

A biomechanical study of standard posterior pelvic ring fixation versus a posterior pedicle screw construct

Injury ◽  
2015 ◽  
Vol 46 (8) ◽  
pp. 1491-1496 ◽  
Author(s):  
Jonathan M. Vigdorchik ◽  
Xin Jin ◽  
Anil Sethi ◽  
Darren T. Herzog ◽  
Bryant W. Oliphant ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pelvic Ring ◽  
Biomechanical Study ◽  
Posterior Pelvic Ring

scholarly journals Posterior pelvic ring fractures: Closed reduction and percutaneous CT-guided sacroiliac screw fixation

1997 ◽  
Vol 20 (4) ◽  
pp. 285-294 ◽  
Author(s):  
Augustinus Ludwig Jacob ◽  
Peter Messmer ◽  
Klaus-Wilhelm Stock ◽  
Norbert Suhm ◽  
Bernard Baumann ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Posterior Pelvic Ring ◽  
Ct Guided ◽  
Sacroiliac Screw ◽  
Pelvic Ring Fractures ◽  
Sacroiliac Screw Fixation

scholarly journals Comparison of Biomechanical Performance of Five Different Treatment Approaches for Fixing Posterior Pelvic Ring Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yongtao Lu ◽  
Yiqian He ◽  
Weiteng Li ◽  
Zhuoyue Yang ◽  
Ruifei Peng ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Plate Fixation ◽  
Fixation Method ◽  
Pelvic Ring Injury ◽  
Posterior Pelvic Ring ◽  
Triangular Osteosynthesis ◽  
Pelvic Injuries ◽  
Posterior Pelvic Ring Injury

Background. A large number of pelvic injuries are seriously unstable, with mortality rates reaching 19%. Approximately 60% of pelvic injuries are related to the posterior pelvic ring. However, the selection of a fixation method for a posterior pelvic ring injury remains a challenging problem for orthopedic surgeons. The aim of the present study is to investigate the biomechanical performance of five different fixation approaches for posterior pelvic ring injury and thus provide guidance on the choice of treatment approach in a clinical setting. Methods. A finite element (FE) model, including the L3-L5 lumbar vertebrae, sacrum, and full pelvis, was created from CT images of a healthy adult. Tile B and Tile C types of pelvic fractures were created in the model. Five different fixation methods for fixing the posterior ring injury (PRI) were simulated: TA1 (conservative treatment), TA2 (S1 screw fixation), TA3 (S1 + S2 screw fixation), TA4 (plate fixation), and TA5 (modified triangular osteosynthesis). Based on the fixation status (fixed or nonfixed) of the anterior ring and the fixation method for PRI, 20 different FE models were created. An upright standing loading scenario was simulated, and the resultant displacements at the sacroiliac joint were compared between different models. Results. When TA5 was applied, the resultant displacements at the sacroiliac joint were the smallest (1.5 mm, 1.6 mm, 1.6 mm, and 1.7 mm) for all the injury cases. The displacements induced by TA3 and TA2 were similar to those induced by TA5. TA4 led to larger displacements at the sacroiliac joint (2.3 mm, 2.4 mm, 4.8 mm, and 4.9 mm), and TA1 was the worst case (3.1 mm, 3.2 mm, 6.3 mm, and 6.5 mm). Conclusions. The best internal fixation method for PRI is the triangular osteosynthesis approach (TA5), followed by S1 + S2 screw fixation (TA3), S1 screw fixation (TA2), and plate fixation (TA4).

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