Clinical application of anterior ring internal fixator system combined with sacroiliac screw fixation in Tile C pelvic fracture treatment

Background How to perform minimally invasive surgery for Tile C pelvic fracture is a major problem in clinical practice. We performed minimally invasive surgery for Tile C pelvic fracture using anterior ring internal fixator systems combined with sacroiliac screw fixation. Objective To investigate the advantages and efficacy of anterior ring internal fixator systems combined with sacroiliac screw fixation in the treatment of Tile C pelvic fracture. Methods From May 2017 to May 2020, 27 patients with Tile C pelvic fracture who underwent anterior ring internal fixator system combined with sacroiliac screw fixation (group A) and 21 patients with Tile C pelvic fracture who underwent plate-screw system combined with sacroiliac screw fixation (group B) were retrospectively analyzed. Results All 48 patients were followed up for more than 12 months, all fractures healed within 3–6 months. The operative time, intraoperative bleeding volume, blood transfusion volume, incision length, hospital stay, complication rate and Majeed score were 63.5 ± 10.7 min, 48.3 ± 27.9 ml, 0 ml, 4.5 ± 0.8 cm, 10.2 ± 2.7 d, 3.7% and 89.7 ± 4.6 points, respectively, in group A and 114.8 ± 19.1 min, 375 ± 315.8 ml, 266.7 ± 326.6 ml, 9.2 ± 3.9 cm, 20.9 ± 5.7 d, 23.8% and 88.7 ± 4.9 points, respectively, in group B. Combined excellent and good rates of the Matta evaluation and Majeed score were 100% in both groups. There were no significant differences in the Matta evaluation or Majeed score between the two groups (both P > 0.05), whereas the operative time, intraoperative bleeding volume, blood transfusion volume, incision length and hospital stay were significantly less in group A (all P < 0.05). Conclusion An anterior ring internal fixator system combined with sacroiliac screw fixation can effectively treat Tile C pelvic fracture, and has advantages, including minimal invasiveness, simple operation, short operative time, safe and reliable features, fewer complications, short hospital stay and a good curative effect.

Iliac Bone Corridors to Host the Transiliac Internal Fixator—An Experimental CT Based Analysis

Background: The transiliac internal fixator (TIFI) is a novel minimally invasive surgical procedure to stabilize posterior pelvic ring fractures. Two bone corridors with different lengths, widths, and angulations are suitable to host screws in the posterior iliac wing. While the length and the width have been described previously, the angulation has not been determined yet. Methods: We created a computer tomography-based 3D-model of 40 patients (20 women, 20 men). The possible bone corridors to host the ilium screws for the TIFIcc (cranio-caudal) and the TIFIdv (dorso-ventral) procedure were identified. After reaching the optimal position, the angles in relation to the sagittal and axial plane were measured. The anterior pelvic plane was chosen as the reference plane. Results: The mean angle of the TIFIcc screws related to the axial plane was 63.4° (±1.8°) and to the sagittal plane was 12.3° (±1.5°). The mean angle of the TIFIdv screws related to the axial plane was 16.1° (±1.2°) and to the sagittal plane was 20.1° (±2.0°). In each group, a high constancy was apparent irrespective of the age or physical dimension of the patient, although a significant gender-dependent difference was observed”. Conclusions: Due to a high inter-individual constancy in length, width, and angulation, bone corridors in the posterior iliac wing are reliable to host screws for posterior pelvic ring fixation irrespective of each individual patient’s anatomy.

Biomechanical study of Tile C3 pelvic fracture fixation using an anterior internal system combined with sacroiliac screws

Background How to perform minimally-invasive surgery on Tile C pelvic fractures is very difficult, and it is also a hot topic in orthopedic trauma research. We applied minimally-invasive treatment using an anterior internal fixator combined with sacroiliac screws. Objectives To compare the biomechanical properties of different fixation models in pelvic facture specimens, using an internal fixation system or a steel plate combined with sacroiliac screws. Methods Sixteen fresh adult cadaver pelvic specimens were randomly separated into four groups named A, B, C, and D. The four groups were respectively stabilized using a two-screwed, three-screwed, or four-screwed anterior internal fixator or a steel plate with sacroiliac screws. All models were tested in both standing and sitting positions. Vertical loads of 600 N were applied increasingly. Shifts of bilateral sacroiliac joints and pubis rupture were measured. Results The shifts in sacroiliac joints and pubis rupture in the standing position were all less than 3.5 mm, and the shifts in the sitting position were all less than 1 mm. In the standing position, the results of shifts in the sacroiliac joints were group C < group D < group B < group A. For comparisons between A:B and C:D, P > 0.05. For comparisons between A, B:C, and D, P < 0.05. The results of shifts in pubis ruptures were group D < group C < group B < group A. In the comparison between C:D, P > 0.05; for comparisons between A:B, A:C, A:D, B:C, and B:D, P < 0.05. In the sitting posture, the results of shifts in the sacroiliac joints were group C < group D < group B < group A, and the shifts in the pubis ruptures were group D < group C < roup B < group A. For comparison between C:D, P > 0.05. For comparisons between A:B, A:C, A:D, B:C, and B:D, P < 0.05. Conclusion Use of an anterior internal fixator combined with sacroiliac screws effectively stabilized Tile C3 pelvic fractures. The stability of specimens increased as the number of screws in the internal fixator increased.

Biomechanical Study of Tile C3 Pelvic Fracture Fixation Using an Anterior Internal System Combined With Sacroiliac Screws

BackgroundThis study aimed to investigate the effectiveness of different methods of fixation of Tile C3 pelvic fractures. We applied minimally-invasive treatment using an anterior internal fixator combined with sacroiliac screws. ObjectivesTo compare the biomechanical properties of different fixation models in pelvic facture specimens, using an internal fixation system or a steel plate combined with sacroiliac screws. MethodsSixteen fresh adult cadaver pelvic specimens were randomly separated into four groups named A, B, C and D. The four groups were respectively stabilized using a two-screwed, three-screwed, or four-screwed anterior internal fixator or a steel plate with sacroiliac screws. All models were tested in both standing and sitting positions. Vertical loads of 600 N were applied increasingly. Shifts of bilateral sacroiliac joints and pubis rupture were measured. ResultsThe shifts in sacroiliac joints and pubis rupture in the standing position were all less than 3.5 mm and the shifts in the sitting position were all less than 1 mm. In the standing position, the results of shifts in the sacroiliac joints were: Group C < Group D < Group B < Group A. For comparisons between A:B and C:D, P > 0.05. For comparisons between A, B:C, D, P < 0.05. The results of shifts in pubis ruptures were: Group D < Group C < Group B < Group A. In the comparison between C:D, P > 0.05, for comparisons between A:B, A:C, A:D, B:C, and B:D, P < 0.05. In the sitting posture, the results of shifts in the sacroiliac joints were: Group C < Group D < Group B < Group A, the shifts in the pubis ruptures were: Group D < Group C < Group B < Group A. For comparison between C:D, P > 0.05. For comparisons between A:B, A:C, A:D, B:C, and B:D, P < 0.05. ConclusionUse of an anterior internal fixator combined with sacroiliac screws effectively stabilized Tile C3 pelvic fractures. Among the options tested, a two-screwed internal fixator combined with sacroiliac screws was easier to operate. The stability of specimens increased as the number of screws in the internal fixator increased.

A systematic review of the transiliac internal fixator (TIFI) for posterior pelvic injuries

Objective: To summarize the literature on transiliac internal fixator (TIFI) indications and outcomes for treating posterior pelvic ring injuries. Methods: We searched databases for original publications in journals. Biomechanical and clinical studies using a TIFI for posterior pelvic ring injuries were considered for inclusion. The dates of publications that were included ranged from January 2000 until December 2020. Results: A total of 13 articles were reviewed, including eight clinical studies and five biomechanical tests. We found only case series and no multicenter or randomized study. The clinical studies contained data for a total of 186 cases, including indications, treatments, complications, and outcomes, with a minimum follow-up time of 12 months. All studies reported superior results according to operation time, blood loss, complication, dislocation, and union. One biomechanical test evaluated inferior results. Conclusions: The TIFI is a user-friendly and safe device to treat posterior pelvic injuries. It can also be used for acute, high-impact injuries, and fragility fractures. Nevertheless, there is no evidence concerning which types of pelvic fractures are most beneficial. Therefore, further biomechanical and clinical studies are necessary to resolve this question.