scholarly journals Trans-obturator Cable Fixation for Disrupted Pubic Symphysis: A Reasonable Option Compared to Plating?

2021 ◽  
Author(s):  
Martin C. Jordan ◽  
Veronika Jaeckle ◽  
Sebastian Scheidt ◽  
Fabian Gilbert ◽  
Stefanie Hoelscher-Doht ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Pubic Symphysis ◽  
Cadaver Study ◽  
Steel Cable ◽  
Reliable Technique ◽  
Peak Displacement ◽  
Total Displacement ◽  
Cable Fixation

Abstract Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

scholarly journals Trans-obturator cable fixation of open book pelvic injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Martin C. Jordan ◽  
Veronika Jäckle ◽  
Sebastian Scheidt ◽  
Fabian Gilbert ◽  
Stefanie Hölscher-Doht ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Pubic Symphysis ◽  
Cadaver Study ◽  
Steel Cable ◽  
Reliable Technique ◽  
Peak Displacement ◽  
Total Displacement ◽  
Cable Fixation

AbstractOperative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

scholarly journals Surgical Correction of the Sequelae of Obstetric Pubic Symphysis Ruptures

2014 ◽  
Vol 21 (4) ◽  
pp. 15-21
Author(s):  
Ya. G Gudushayri ◽  
A. F Lazarev ◽  
A. V Verzin
Keyword(s):  
Bladder Dysfunction ◽  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Pubic Symphysis ◽  
Time Interval ◽  
Subjective Improvement ◽  
Roentgenologic Examination ◽  
Urodynamic Investigation ◽  
Reliable Technique ◽  
Bladder Disorders

Twenty eight patients with old postpartum ruptures of pubic symphysis complicated by functional bladder disorders were operated on during the period from 2000 to 2013. Time interval between vaginal delivery and pelvic ring stabilization made up from 1 month to 8 years. Clinical and roentgenologic examination enabled to detect predisposing factors for neurogenic, i.e. hyperactive bladder development that were treated surgically. In all cases plate osteosynthesis for pubic symphysis and fixation of sacroiliac joint with cannulated screws was performed. Subjective improvement of patients’ condition as well as the results of uroflowmetry and complex urodynamic investigation enabled to conclude that orthopaedic reconstruction of pelvic ring in old obstetric ruptures of pubic symphysis was an effective and reliable technique for the treatment of bladder dysfunction.

scholarly journals Surgical Correction of the Sequelae of Obstetric Pubic Symphysis Ruptures

2014 ◽  
pp. 15-21 ◽  
Author(s):  
Ya. G. Gudushayri ◽  
A. F. Lazarev ◽  
A. V. Verzin
Keyword(s):  
Bladder Dysfunction ◽  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Pubic Symphysis ◽  
Time Interval ◽  
Subjective Improvement ◽  
Roentgenologic Examination ◽  
Urodynamic Investigation ◽  
Reliable Technique ◽  
Bladder Disorders

Twenty eight patients with old postpartum ruptures of pubic symphysis complicated by functional bladder disorders were operated on during the period from 2000 to 2013. Time interval between vaginal delivery and pelvic ring stabilization made up from 1 month to 8 years. Clinical and roentgenologic examination enabled to detect predisposing factors for neurogenic, i.e. hyperactive bladder development that were treated surgically. In all cases plate osteosynthesis for pubic symphysis and fixation of sacroiliac joint with cannulated screws was performed. Subjective improvement of patients’ condition as well as the results of uroflowmetry and complex urodynamic investigation enabled to conclude that orthopaedic reconstruction of pelvic ring in old obstetric ruptures of pubic symphysis was an effective and reliable technique for the treatment of bladder dysfunction.

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

Strength of side-to-side and step-cut repairs in tendon transfers: biomechanical testing of porcine flexor tendons

2020 ◽  
Vol 45 (10) ◽  
pp. 1061-1065
Author(s):  
Eivind Strandenes ◽  
Peter Ellison ◽  
Anders O. Mølster ◽  
Nils R. Gjerdet ◽  
Irene O. Moldestad ◽  
...  
Keyword(s):  
Tensile Properties ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Maximum Load ◽  
Side Group ◽  
Tendon Transfers ◽  
Flexor Tendons ◽  
Active Mobilization ◽  
The Difference

The aim of the study was to compare side-to-side with step-cut repairs to determine how much of the width it is possible to remove and still keep the repair strong enough to start active mobilization. Porcine flexor tendons were used to create side-to-side, one-third step-cut and half step-cut repairs. There were 15 repairs in each group. The tensile properties of the constructs were measured in a biomechanical testing machine. All repairs failed by the sutures splitting the tendon longitudinally. The maximum load and stiffness were highest in the side-to-side group. Our findings suggest that the half step-cut repair can withstand the forces exerted during active unrestricted movement of the digits in tendons of this size. The advantage of the step-cut repair is reduced bulkiness and less friction, which might compensate for the difference in strength.

Biomechanical characteristics of C1–2 cable fixations

1996 ◽  
Vol 85 (2) ◽  
pp. 316-322 ◽  
Author(s):  
Curtis A. Dickman ◽  
Neil R. Crawford ◽  
Christopher G. Paramore
Keyword(s):  
Cyclic Loading ◽  
Translational Motion ◽  
Biomechanical Testing ◽  
Three Dimensional ◽  
Constrained Motion ◽  
Content Type ◽  
Physiological Range ◽  
Fixation Techniques ◽  
Cable Fixation ◽  
Fine Print

✓ The biomechanical characteristics of four different methods of C1–2 cable fixation were studied to assess the effectiveness of each technique in restoring atlantoaxial stability. Biomechanical testing was performed on the upper cervical spines of four human cadaveric specimens. Physiological range loading was applied to the atlantoaxial specimens and three-dimensional motion was analyzed with stereophotogrammetry. The load–deformation relationships and kinematics were measured, including the stiffness, the angular ranges of motion, the linear ranges of motion, and the axes of rotation. Specimens were nondestructively tested in the intact state, after surgical destabilization, and after each of four different methods of cable fixation. Cable fixation techniques included the interspinous technique, the Brooks technique, and two variants of the Gallie technique. All specimens were tested immediately after fixation and again after the specimen was fatigued with 6000 cycles of physiological range torsional loading. All four cable fixation methods were moderately flexible immediately; the different cable fixations allowed between 5° and 40° of rotational motion and between 0.6 and 7 mm of translational motion to occur at C1–2. The Brooks and interspinous methods controlled C1–2 motion significantly better than both of the Gallie techniques. The motion allowed by one of the Gallie techniques did not differ significantly from the motion of the unfixed destabilized specimens. All cable fixation techniques loosened after cyclic loading and demonstrated significant increases in C1–2 rotational and translational motions. The bone grafts shifted during cyclic loading, which reduced the effectiveness of the fixation. The locations of the axes of rotation, which were unconstrained and mobile in the destabilized specimens, became altered with cable fixation. The C1–2 cables constrained motion by shifting the axes of rotation so that C-1 rotated around the fixed cable and graft site. After the specimen was fatigued, the axes of rotation became more widely dispersed but were usually still localized near the cable and graft site. Adequate healing requires satisfactory control of C1–2 motion. Therefore, some adjunctive fixation is advocated to supplement the control of motion after C1–2 cable fixation (that is, a cervical collar, a halo brace, or rigid internal fixation with transarticular screws).

scholarly journals Failure of Internal Fixation of The Anterior Ring For Unstable Pelvic Fractures, The Experience of A Single Institute

2021 ◽  
Author(s):  
Sheng Zhang ◽  
Huagui Mo ◽  
Yucheng Liu ◽  
Guohua Zhu ◽  
Bin Yu
Keyword(s):  
Internal Fixation ◽  
Pelvic Ring ◽  
Treatment Strategies ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Fixation Failure ◽  
Initial Surgery ◽  
Multidisciplinary Cooperation ◽  
Preoperative Plan ◽  
Anterior Ring

Abstract Background: This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials: From January 2009 to December 2018, 93 patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system.Results: According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5-28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients were fixed with a plate. Five patients undergoing revision surgery were followed up for 6-36 months with an average of 18 months. According to Majeedscore at the last follow-up, there were 2 cases of excellent, 2 cases of good, 1 case of fair, and the excellent and good rate reached 80%.Conclusion: The treatment of complicated unstable pelvic fractures requires early multidisciplinary cooperation, proper management of hemodynamic stability and other comorbidities, and performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

The effect of contouring the connecting bar in an acrylic-pin external fixator

2001 ◽  
Vol 14 (04) ◽  
pp. 190-195 ◽  
Author(s):  
E. L. Egger ◽  
G. D. Herndon
Keyword(s):  
Ultimate Strength ◽  
Axial Compression ◽  
External Fixator ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Catastrophic Failure ◽  
High Stiffness

This studies the effects of contouring of acrylic column when placed in axial compression. Six different angles were studied, 0°, 30°, 45°, 60°, 90° and a 90° with a 2.0 mm connecting bar. Each column was then placed under axial compression using a biomechanical testing machine. As the angle of the contour increased there was a significant decrease in the ultimate stiffness and ultimate strength of the columns. However, the amount of force required to cause catastrophic failure in any of the group was still high (stiffness 300 N/mm ± 70, ultimate strength 1032 N ± 139) which may not be reached in a physiological setting. When using a severe angulation of the column the using of a connecting bar will significantly increase both stiffness and strength of the acrylic.

Overlapping Dislocation of the Pubic Symphysis with an Open Reduction and Anterior and Posterior Pelvic Ring Fixation

2015 ◽  
Vol 5 (1) ◽  
pp. e6 ◽  
Author(s):  
Alan T. Blank ◽  
Mark Gage ◽  
Nirmal Tejwani ◽  
Toni McLaurin
Keyword(s):  
Open Reduction ◽  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Posterior Pelvic Ring

scholarly journals Biomechanical properties of a novel biodegradable magnesium-based interference screw

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Marco Ezechieli ◽  
Hanna Meyer ◽  
Arne Lucas ◽  
Patrick Helmecke ◽  
Christoph Becher ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Interference Screw ◽  
Biomechanical Analysis ◽  
Interference Screws ◽  
Standard Implant ◽  
Biodegradable Magnesium

Magnesium-based interference screws may be an alternative in anterior/posterior cruciate ligament reconstruction. The well-known osteoconductive effects of biodegradable magnesium alloys may be useful. It was the purpose of this study to evaluate the biomechanical properties of a magnesium based interference screw and compare it to a standard implant. A MgYREZr-alloy interference screw and a standard implant (Milagro®; De Puy Mitek, Raynham, MA, USA) were used for graft fixation. Specimens were placed into a tensile loading fixation of a servohydraulic testing machine. Biomechanical analysis included pretensioning of the constructs at 20 N for 1 min following cyclic pretensioning of 20 cycles between 20 and 60 N. Biomechanical elongation was evaluated with cyclic loading of 1000 cycles between 50 and 200 N at 0.5 Hz. Maximum load to failure was 511.3±66.5 N for the Milagro® screw and 529.0±63.3 N for magnesium-based screw (ns, P=0.57). Elongations after preload, during cyclical loading and during failure load were not different between the groups (ns, P>0.05). Stiffness was 121.1±13.8 N/mm for the magnesiumbased screw and 144.1±18.4 for the Milagro® screw (ns, P=0.32). MgYREZr alloy interference screws show comparable results in biomechanical testing to standard implants and may be an alternative for anterior cruciate reconstruction in the future.

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