A biomechanics study on ligamentous injury in anterior posterior compression type II pelvic injury

Abstract Background: Anterior posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury.Method: Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments.Result: When ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 mm to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05).Conclusion: Pelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.

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A biomechanics study on ligamentous injury in anterior posterior compression type II pelvic injury

10.21203/rs.3.rs-24176/v3 ◽

2020 ◽

Author(s):

Jianzhong Kong ◽

Yupeng Chu ◽

Chengwei Zhou ◽

Shuaibo Sun ◽

Guodong Bao ◽

...

Keyword(s):

Sacroiliac Joint ◽

Rotation Angle ◽

External Rotation ◽

Pubic Symphysis ◽

Pelvic Injury ◽

Pelvic Bone ◽

Type Ii ◽

Significant Difference ◽

Joint Separation ◽

Anterior Posterior

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A biomechanics study about ligaments injury in anterior posterior compression type Ⅱ pelvic injury

10.21203/rs.3.rs-24176/v1 ◽

2020 ◽

Author(s):

jianzhong kong ◽

Yupeng Chu ◽

Chengwei Zhou ◽

shuaibo Sun ◽

guodong Bao ◽

...

Keyword(s):

Sacroiliac Joint ◽

Rotation Angle ◽

External Rotation ◽

Pubic Symphysis ◽

Separation Distance ◽

Pelvic Injury ◽

Type Ii ◽

Pelvis Fracture ◽

Restricted Group ◽

Anterior Posterior

Abstract Background Anterior posterior compression(APC)type II pelvis fracture is considered to be a typical one caused by the destruction of pelvic ligaments, while the mechanism of ligaments injury is still controversial. This study aims to explore ligaments injury in APC type II pelvic injury. Method: Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL) and partial bone retaining unilaterally were made for this study. They were divided into hemipelvis restricted group and unrestricted group randomly. Record the separation distance of pubic symphysis and anterior sacroiliac joint, external rotation angle and force when the ASL ruptured. Continuing external rotation violence, observing bone and pelvic ligaments change. Result When ASL failed, there were no significant differences in mean separation distance of pubic symphysis (28.6 ± 8.4 mm to 23.6 ± 8.2 mm,P = 0.11) and anterior sacroiliac joint (11.4 ± 3.8 mm to 9.7 ± 3.9 mm ,P = 0.30) between restricted group and unrestricted group, but external rotation angle(33.9 ± 5.5° to 48.9 ± 5.2°,P < 0.01) and force(553.9 ± 82.6 N to 756.6 ± 41.4 N,P < 0.01) were not. In restricted group, both of SAL and SPL injury occurred, which was different in unrestricted group. Besides, separation distance of pubic symphysis between two groups ranged from 14 mm to 40 mm. With external rotation violence continuing, SPL ruptured firstly, then SBL ruptured and the interosseous sacroiliac ligament was damaged while posterior ligament was not; in another group, interosseous sacroiliac ligament, posterior sacroiliac ligaments were damaged while SAC and SPL were not. When all of ASL, SBL, SPL failed, mean separation distance of pubic symphysis and anterior sacroiliac joint between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05). Conclusion First, pelvic external rotation injury can divide into hemipelvis is restricted and unrestricted, which result into different outcomes; When ASL ruptures, the unrestricted group needs more external rotation angle and force, without SBL or SPL injury. But in restricted group, both of two ligaments are injured. Second, when ASL fails, pubic symphysis displacement has a high fluctuation. Third, ASL rupture does not mean SBL and SPL are injured inevitably.

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A biomechanics study about the mechanism of ligaments injury in anterior posterior compression type Ⅱ pelvic injury

10.21203/rs.3.rs-22184/v1 ◽

2020 ◽

Author(s):

xiaolong Shui ◽

Jianzhong kong ◽

Yupeng Chu ◽

Chengwei Zhou ◽

Shuaibo Sun ◽

...

Keyword(s):

Sacroiliac Joint ◽

Rotation Angle ◽

External Rotation ◽

Pubic Symphysis ◽

Separation Distance ◽

Pelvic Injury ◽

Control Group ◽

Sacrospinous Ligament ◽

Restricted Group ◽

Anterior Posterior

Abstract Background The anterior and posterior compression (APC) pelvis fracture is a classic pelvic injury, and APC type II is considered to be a typical one caused by the destruction of pelvic ligaments, while the mechanism of ligaments injury and treatment of which is still controversial. This study aims to explore ligaments injury in anterior posterior compression(APC)type II pelvic injury. Method: Fourteen human cadaveric pelvis samples (5 female, 9 male) with the sacrospinous, sacrotuberous, anterior sacroiliac ligaments and partial bone retaining unilaterally were made for this study. To simulate the APC pattern pelvic injury, the samples were divided into two groups randomly, set one group as hemipelvis restricted group (experimental group) and the other one as unrestricted group (control group). According to the biomechanical data, eye observation, motion capture system and real-time video system to record the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle and force when the anterior sacroiliac ligament ruptured. Continuing the external rotation violence, observing the bone and posterior ligaments change since sacrospinous and sacrotuberous ligaments from being damaged to completely ruptured. Result When anterior sacroiliac ligament failed, the mean separation distance of pubic symphysis and anterior sacroiliac joint between restricted group and unrestricted group was 28.6 ± 8.4 mm to 23.6 ± 8.2 mm(P = 0.11) and 11.4 ± 3.8 mm to 9.7 ± 3.9 mm (P = 0.30) respectively. In addition, the external rotation angle and force was 33.9 ± 5.5° to 48.9 ± 5.2°(P < 0.01) and 553.9 ± 82.6 N to 756.6 ± 41.4 N (P < 0.01) respectively. The two distances were not significantly different (P > 0.05), however, the external rotation angle and violence was significantly different (P < 0.05), which was bigger in the unrestricted group. In the unrestricted group, when anterior sacroiliac ligament ruptured, no distinct sacrospinous or sacrotuberous ligaments injury was observed, but in the restricted group, all of samples had two ligaments injury and even two samples had ligaments failed. Moreover, with the extreme external rotation violence continuing, there was still no sacrospinous or sacrotuberous ligaments injury in the unrestricted group. But interosseous sacroiliac ligament, posterior sacroiliac ligaments injury and slight sagittal rotation and sacroiliac joint displacement appeared. In the control group, the sacrospinous ligament ruptured firstly and then the sacrotuberous ligament ruptured. When both of the two ligaments failed, the interosseous sacroiliac ligament was damaged while posterior ligament was not. In the restricted group, when all of the anterior sacroiliac ligament, sacrospinous ligament or sacrotuberous ligament failed, mean separation distance of pubic symphysis and anterior sacroiliac joint increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05). Conclusion We have three main findings: First, pelvic external rotation injury can divide into two situations: hemipelvis is restricted and unrestricted, which result into two different outcomes. When anterior sacroiliac ligament rupture, the unrestricted group needs more external rotation angle and force, without obvious sacrotuberous or sacrospinous ligaments injury. But in the restricted group, both of two ligaments injury appear. Second, when anterior sacroiliac ligament fail, pubic symphysis displacement ranges from 14 to 40 mm, which has a high fluctuation. Third, when the anterior sacroiliac ligament is damaged, we dose not observe the inevitable destruction of the pelvic floor ligaments (sacrospinous ligament and sacrotubercular ligament).

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Combined peripartal pubic symphysis and sacroiliac joint separation

Česká gynekologie ◽

10.48095/cccg202130 ◽

2021 ◽

Vol 86 (1) ◽

pp. 30-35

Author(s):

Tomáš Hriň ◽

◽

Radomír Gajdoš ◽

Karol Dókuš

Keyword(s):

Sacroiliac Joint ◽

Pubic Symphysis ◽

Joint Separation

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The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis

Advances in Orthopedics ◽

10.1155/2021/6668467 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Chengxin Li ◽

Zhizhuo Li ◽

Qiwei Wang ◽

Lijun Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

External Rotation ◽

Meta Analysis ◽

Distal Tibia ◽

Valgus Deformity ◽

Cochrane Library ◽

Control Group ◽

Radiographic Outcomes ◽

Significant Difference ◽

Fibular Fixation ◽

Anterior Posterior

Objectives. The necessity of fibular fixation in distal tibia-fibula fractures remains controversial. This study aimed to assess its impact on radiographic outcomes as well as rates of nonunion and infection. Methods. A systematic search of the electronic databases of PubMed, Embase, and Cochrane library was performed to identify studies comparing the outcomes of reduction and internal fixation of the tibia with or without fibular fixation. Radiographic outcomes included malalignment and malrotation of the tibial shaft. Data regarding varus/valgus angulation, anterior/posterior angulation, internal/external rotation deformity, and the rates of nonunion and infection were extracted and then polled. A meta-analysis was performed using the random-effects model for heterogeneity. Results. Additional fibular fixation was statistically associated with a decreased rate of rotation deformity (OR = 0.13; 95% CI 0.02–0.82,p=0.03). However, there was no difference in the rate of malreduction between the trial group and the control group (OR = 0.86; 95% CI 0.27–2.74,p=0.80). There was also no difference in radiographic outcomes of varus-valgus deformity rate (OR = 0.17; 95% CI 0.03–1.00,p=0.05) or anterior-posterior deformity rate (OR = 0.76; 95% CI 0.02–36.91,p=0.89) between the two groups. Meanwhile, statistical analysis showed no significant difference in the nonunion rate (OR = 0.62; 95% CI 0.37–1.02,p=0.06) or the infection rate (OR = 0.81; 95% CI 0.18–3.67,p=0.78) between the two groups. Conclusions. Additional fibular fixation does not appear to reduce the rate of varus-valgus deformity, anterior-posterior deformity, or malreduction. Meanwhile, it does not appear to impair the union process or increase the odds of infection. However, additional fibular fixation was associated with decreased odds of rotation deformity compared to controls.

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Anterior-Posterior Translation and Axial Rotation of the Fibula are Significantly Increased with Sequential Disruption of the Syndesmosis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000303 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Conor Murphy ◽

Thomas Pfeiffer ◽

Jason Zlotnicki ◽

Volker Musahl ◽

Richard Debski ◽

...

Keyword(s):

External Rotation ◽

Optical Tracking ◽

Flexion Angle ◽

Rotational Instability ◽

Syndesmotic Injury ◽

Combined Injury ◽

Tibiofibular Ligament ◽

Significant Difference ◽

Posterior Translation ◽

Anterior Posterior

Category: Ankle, Sports, Trauma Introduction/Purpose: Injury to the Anterior inferior tibiofibular ligament (AITFL), Posterior inferior tibiofibular ligament (PITFL) and Interosseus membrane (IOM) predicts residual symptoms in ankle sprains. Limited kinematic knowledge of the tibiofibular joint results in missed diagnosis and poor clinical outcomes. Lateral fibular displacement on radiologic assessment signifies syndesmotic disruption which dictates operative management. Previous studies demonstrated that fibular motion is multiplanar after injury. The objective of this study is to determine increases in fibular motion with sequential syndesmotic injury and the contribution of the AITFL. Methods: Five fresh-frozen human cadaveric tibial plateau-to-toe specimens with a mean age of 58 years (range 38-73 years) were tested using a 6-degree-of-freedom robotic testing system. The tibia and calcaneus were rigidly fixed. The subtalar joint was fused. The full fibular length was maintained and fibular motion was unconstrained. A 5 Nm external rotation and 5 Nm inversion moment were applied to the ankle at 0°, 15°, and 30° plantarflexion and 10° dorsiflexion. The motion of the fibula was tracked by a 3D optical tracking system. Outcome variables included fibular medial-lateral (ML) translation, anterior-posterior (AP) translation, and external rotation (ER) during each applied moment and flexion angle in the following conditions: 1) intact ankle, 2) AITFL transected, 3) PITFL and IOM transected. Statistical analysis included an ANOVA with a post-hoc Tukey analysis to compare the changes in fibular motion between the intact and injury models at each applied moment and flexion angle (*p<0.05). Results: The only significant differences in fibular motion were during the 5 Nm inversion moment. The posterior translation of the fibula was significantly greater with AITFL injury compared to the intact ankle at 15° and 30° plantarflexion. Significant increases in posterior translation between the intact ankle and AITFL, PITFL, and IOM injury existed at 0°, 15°, and 30° plantarflexion. No significant motion differences were observed between the AITFL injury and combined injury at any condition. When comparing the intact ankle and combined injury, significant increases in ER existed at 0° and 30° plantarflexion and 10° dorsiflexion. The only significant difference in ER between the intact ankle and AITFL injury existed at 0° plantarflexion. Conclusion: This study showed that transecting the AITFL resulted in the largest increases in fibular motion with only minimal further increases after complete syndesmotic injury. Fibular displacement was primarily in the sagittal plane. This study utilized a novel setup with unconstrained motion in a full length, intact fibula. Measuring ML translation alone could underestimate sagittal and rotational instability of the syndesmosis in AITFL injuries. Evaluating fibular AP translation and ER are not part of current standard diagnostic protocols. Physicians may consider more aggressive treatment of isolated AITFL injuries.

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Treatment sequence of combined pelvic injury, consisted of upper pubic ramus fracture, sacroiliac joint dislocation with open book injury, using Stoppa approach

American Journal of Orthopedic Research and Reviews ◽

10.28933/ajorr-2021-09-1705 ◽

2021 ◽

pp. 27

Author(s):

Keyword(s):

Sacroiliac Joint ◽

Degrees Of Freedom ◽

Pubic Symphysis ◽

Pelvic Injury ◽

Type I ◽

Open Book ◽

Pubic Ramus ◽

Ilioinguinal Approach ◽

Sacroiliac Joint Disruption ◽

Stoppa Approach

Among pelvic serious injuries is the so-called “open book” injury of the pelvis, with Sacroiliac Joint Disruption (SIJD) in combination with upper pubic ramus or anterior column fracture, contralateral or ipsilateral, or both. This combination of pelvic injury could be classified according Young and Burgess classification as LCIII or CM type (Combined Mechanism) and as 61-B3.1 61-B3.2 following AO/OTA classification. Specifically, the upper pubic ramus fracture can be classified according to Nakatani classification as type I medial of the foramen, type II within the foramen and type III lateral to the foramen. The difficulty to deal with these fractures is how to close and reduct the pubic symphysis in mechanically stable way since there is fracture in one or both the upper pubic ramus. The existence of these fractured elements, in this type of pelvis injury allow a lot of degrees of freedom which must be managed from the surgeon in the proper sequence. The incision and the approach are also mandatory for successfully treating these lesions. Anterior Intrapelvic Approach (AIP) or Stoppa approach in conjunction with the first window of ilioinguinal approach is the most appropriate surgical exposure for reduction and fixation.

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Anatomical Shoulder Movement Strength Imbalance Among Water Polo Overhead Athletes

International Journal of Kinesiology and Sports Science ◽

10.7575/aiac.ijkss.v.7n.2p.15 ◽

2019 ◽

Vol 7 (2) ◽

pp. 15

Author(s):

Pooya Nekooei ◽

Tengku-Fadilah T.K ◽

Saidon Amri ◽

Roselan Bin Baki ◽

Sara Majlesi ◽

...

Keyword(s):

External Rotation ◽

T Test ◽

P Value ◽

Overhead Athletes ◽

Water Polo ◽

Shoulder Movement ◽

Posterior Shoulder ◽

Significant Difference ◽

Flexion Extension ◽

Anterior Posterior

Background: The game of water polo has become more familiar to all the athletes and coaches as the time has passed. It has been played as a sport for more than a century Although anatomical shoulder movement strength balance is a crucial factor in overhead throwers’ performance, it has not been studied extensively in the previous research. Objective: This study examined shoulder movement imbalance in bilateral and dominant anterior-posterior shoulder among 42 elite water polo players in Malaysia. Method: The t-test analyses of data obtained through several tests proved that water polo players had statistically significant difference between their right hand anatomical shoulder movement strength and their left hand anatomical shoulder movement strength in all eight shoulder movements, i.e. Flexion, Extension, Abduction, Adduction, Horizontal Adduction, Horizontal Abduction, Rotation and External Rotation. Results: The results of this study showed that there are significant differences of anatomical shoulder movement strength in both bilateral and Anterior-posterior shoulder movement among water polo players. The statistics results for bilateral shoulder movement of Flexion (t= 136.09 and p<.001), Extension (t= 110.92 and p<.001), Abduction (t= 121.89 and p<.001), Adduction (t= 101.47 and p<.001), Horizontal Adduction (t= 92.3 and p<.001), Horizontal Abduction (t= 95.6 and p<.001), Internal rotations (t= 109.6 and p<.001) and External rotations (t= 102.18 and p<.001) showed the p-value to be less than 0.05 for all variables of the test. The result of paired samples t-test showed there is a statistically significant difference between the mean of bilateral anatomical shoulder movement strength among water polo players. Conclusion: These findings suggest that coaches and players should take into account the shoulder movement strength imbalance in their trainings and design specific training programs to improve overhead throwers’ shoulder movement strength balance and hence their throwing performance in sports such as water polo.

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Sacroiliac Separation that Can be Diagnosed After Pelvic Fixation During Surgery: A Case Report and Review of Literature

10.21203/rs.3.rs-606099/v1 ◽

2021 ◽

Author(s):

ibrahim alper yavuz ◽

tahsin aydın ◽

ahmet ozgur yildirim

Keyword(s):

Sacroiliac Joint ◽

Pelvic Injury ◽

Case Presentation ◽

Sacroiliac Screw ◽

Pelvic Fixation ◽

Pelvic Injuries ◽

Pelvic Binder ◽

Direct Radiography ◽

Life Threatening ◽

Joint Separation

Abstract Introduction: Sacroiliac joint separation is a life-threatening serious condition in pelvic injuries. It should be diagnosed early and treated properly. Although these injuries can often be detected by imaging methods, in some cases, it is not diagnosed. Case presentation: We report a rare case of pelvic injury with sacroiliac separation during surgery, while the sacroiliac joint was completely normal on X-ray and CT and no pelvic binder was used in the patient. The sacroiliac separation noticed during the operation was fixed with a sacroiliac screw. Conclusion: Pelvic injuries, especially ligament injuries, may not be detected on both physical examination, direct radiography, and CT.

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Nerve graft versus nerve transfer for neonatal brachial plexus: shoulder outcomes

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds2027 ◽

2021 ◽

Vol 27 (1) ◽

pp. 87-92

Author(s):

Brandon W. Smith ◽

Kate W. C. Chang ◽

Sravanthi Koduri ◽

Lynda J. S. Yang

Keyword(s):

Brachial Plexus ◽

Clinical Data ◽

External Rotation ◽

Nerve Transfer ◽

Shoulder Function ◽

Nerve Transfers ◽

Shoulder Flexion ◽

Significant Difference ◽

Transfer Strategies ◽

Shoulder External Rotation

OBJECTIVEThe decision-making in neonatal brachial plexus palsy (NBPP) treatment continues to have many areas in need of clarification. Graft repair was the gold standard until the introduction of nerve transfer strategies. Currently, there is conflicting evidence regarding outcomes in patients with nerve grafts versus nerve transfers in relation to shoulder function. The objective of this study was to further define the outcomes for reconstruction strategies in NBPP with a specific focus on the shoulder.METHODSA cohort of patients with NBPP and surgical repairs from a single center were reviewed. Demographic and standard clinical data, including imaging and electrodiagnostics, were gathered from a clinical database. Clinical data from physical therapy evaluations, including active and passive range of motion, were examined. Statistical analysis was performed on the available data.RESULTSForty-five patients met the inclusion criteria for this study, 19 with graft repair and 26 with nerve transfers. There were no significant differences in demographics between the two groups. Understandably, there were no patients in the nerve grafting group with preganglionic lesions, resulting in a difference in lesion type between the cohorts. There were no differences in preoperative shoulder function between the cohorts. Both groups reached statistically significant improvements in shoulder flexion and shoulder abduction. The nerve transfer group experienced a significant improvement in shoulder external rotation, from −78° to −28° (p = 0.0001), whereas a significant difference was not reached in the graft group. When compared between groups, there appeared to be a trend favoring nerve transfer in shoulder external rotation, with the graft patients improving by 17° and the transfer patients improving by 49° (p = 0.07).CONCLUSIONSIn NBPP, patients with shoulder weakness experience statistically significant improvements in shoulder flexion and abduction after graft repair or nerve transfer, and patients with nerve transfers additionally experience significant improvement in external rotation. With regard to shoulder external rotation, there appear to be some data supporting the use of nerve transfers.

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