When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study
Purpose This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C). Methods An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foram...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2015-12, Vol.41 (6), p.665-671 |
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| creator | Mcdonald, E. Theologis, A. A. Horst, P. Kandemir, U. Pekmezci, M. |
| description | Purpose
This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C).
Methods
An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated.
Results
The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18–7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (
p
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| doi_str_mv | 10.1007/s00068-014-0482-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1744659926</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1744659926</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-555d88135dc446eb99f74fa3d9b3a189bf6e97142315eb6393c339d1ca7e02aa3</originalsourceid><addsrcrecordid>eNp1kctKJDEUhoM4eH8ANxJwo4uaSSp1SVbSNF4GhNkoLkMqOaWR6kqbVIn9Cj71nLJbkYHZJP9JvvOHnJ-QY85-csbqX4kxVsmM8SJjhcwzuUX2uKxEplTBt7-0ELtkP6VnhFlV5jtkN6-YkFjukfeHJ-ipC9T0A0QfIoU3FL3pKGrfb3Tr38wQYqLLGF69A2qc84MP010aTOM7P6wQRxs69tNJB_TszuM6P6dL6F69pW00dhgjXNAZbXxYgH0yvbcfFqNbHZIfrekSHG32A3J_dXk3v8lu_1z_ns9uM1sU-ZCVZemk5KJ0WFfQKNXWRWuEU40wXKqmrUDVvMgFL6GphBJWCOW4NTWw3BhxQM7WvviXlxHSoBc-Weg600MYk-Y1-pZK5RWip_-gz2GcBvJBKZyikAopvqZsDClFaPUy-oWJK82ZnoLS66A0BqWnoLTEnpON89gswH11fCaDQL4GEl71jxC_Pf1f17_6t57a</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1749603389</pqid></control><display><type>article</type><title>When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Mcdonald, E. ; Theologis, A. A. ; Horst, P. ; Kandemir, U. ; Pekmezci, M.</creator><creatorcontrib>Mcdonald, E. ; Theologis, A. A. ; Horst, P. ; Kandemir, U. ; Pekmezci, M.</creatorcontrib><description>Purpose
This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C).
Methods
An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated.
Results
The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18–7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (
p
< 0.05). Rotation of the pubis and sacrum was not different between In-Fix constructs combined with single-level IS and TS fixation.
Conclusion
In this model of an unstable pelvic fracture (OTA 61-C), anterior fixation with an In-Fix was biomechanically superior to an anterior Ex-Fix in the setting of single-level posterior fixation. There was no biomechanical difference between the In-Fix and Ex-Fix when each was combined with two levels of posterior sacral fixation.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-014-0482-8</identifier><identifier>PMID: 26038006</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Analysis ; Biomechanical Phenomena - physiology ; Biomechanics ; Bone Screws ; Critical Care Medicine ; Emergency Medicine ; External Fixators ; Fracture Fixation - instrumentation ; Fracture Fixation - methods ; Fractures ; Fractures, Bone - physiopathology ; Fractures, Bone - surgery ; Humans ; Intensive ; Internal Fixators ; Medicine ; Medicine & Public Health ; Models, Anatomic ; Original Article ; Pelvic Bones - physiopathology ; Pelvic Bones - surgery ; Prosthesis Failure ; Sacrum - injuries ; Sports Medicine ; Studies ; Surgery ; Surgical Orthopedics ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2015-12, Vol.41 (6), p.665-671</ispartof><rights>Springer-Verlag Berlin Heidelberg 2014</rights><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-555d88135dc446eb99f74fa3d9b3a189bf6e97142315eb6393c339d1ca7e02aa3</citedby><cites>FETCH-LOGICAL-c442t-555d88135dc446eb99f74fa3d9b3a189bf6e97142315eb6393c339d1ca7e02aa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-014-0482-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-014-0482-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26038006$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mcdonald, E.</creatorcontrib><creatorcontrib>Theologis, A. A.</creatorcontrib><creatorcontrib>Horst, P.</creatorcontrib><creatorcontrib>Kandemir, U.</creatorcontrib><creatorcontrib>Pekmezci, M.</creatorcontrib><title>When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Purpose
This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C).
Methods
An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated.
Results
The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18–7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (
p
< 0.05). Rotation of the pubis and sacrum was not different between In-Fix constructs combined with single-level IS and TS fixation.
Conclusion
In this model of an unstable pelvic fracture (OTA 61-C), anterior fixation with an In-Fix was biomechanically superior to an anterior Ex-Fix in the setting of single-level posterior fixation. There was no biomechanical difference between the In-Fix and Ex-Fix when each was combined with two levels of posterior sacral fixation.</description><subject>Analysis</subject><subject>Biomechanical Phenomena - physiology</subject><subject>Biomechanics</subject><subject>Bone Screws</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>External Fixators</subject><subject>Fracture Fixation - instrumentation</subject><subject>Fracture Fixation - methods</subject><subject>Fractures</subject><subject>Fractures, Bone - physiopathology</subject><subject>Fractures, Bone - surgery</subject><subject>Humans</subject><subject>Intensive</subject><subject>Internal Fixators</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Models, Anatomic</subject><subject>Original Article</subject><subject>Pelvic Bones - physiopathology</subject><subject>Pelvic Bones - surgery</subject><subject>Prosthesis Failure</subject><subject>Sacrum - injuries</subject><subject>Sports Medicine</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kctKJDEUhoM4eH8ANxJwo4uaSSp1SVbSNF4GhNkoLkMqOaWR6kqbVIn9Cj71nLJbkYHZJP9JvvOHnJ-QY85-csbqX4kxVsmM8SJjhcwzuUX2uKxEplTBt7-0ELtkP6VnhFlV5jtkN6-YkFjukfeHJ-ipC9T0A0QfIoU3FL3pKGrfb3Tr38wQYqLLGF69A2qc84MP010aTOM7P6wQRxs69tNJB_TszuM6P6dL6F69pW00dhgjXNAZbXxYgH0yvbcfFqNbHZIfrekSHG32A3J_dXk3v8lu_1z_ns9uM1sU-ZCVZemk5KJ0WFfQKNXWRWuEU40wXKqmrUDVvMgFL6GphBJWCOW4NTWw3BhxQM7WvviXlxHSoBc-Weg600MYk-Y1-pZK5RWip_-gz2GcBvJBKZyikAopvqZsDClFaPUy-oWJK82ZnoLS66A0BqWnoLTEnpON89gswH11fCaDQL4GEl71jxC_Pf1f17_6t57a</recordid><startdate>20151201</startdate><enddate>20151201</enddate><creator>Mcdonald, E.</creator><creator>Theologis, A. A.</creator><creator>Horst, P.</creator><creator>Kandemir, U.</creator><creator>Pekmezci, M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20151201</creationdate><title>When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study</title><author>Mcdonald, E. ; Theologis, A. A. ; Horst, P. ; Kandemir, U. ; Pekmezci, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-555d88135dc446eb99f74fa3d9b3a189bf6e97142315eb6393c339d1ca7e02aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Analysis</topic><topic>Biomechanical Phenomena - physiology</topic><topic>Biomechanics</topic><topic>Bone Screws</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>External Fixators</topic><topic>Fracture Fixation - instrumentation</topic><topic>Fracture Fixation - methods</topic><topic>Fractures</topic><topic>Fractures, Bone - physiopathology</topic><topic>Fractures, Bone - surgery</topic><topic>Humans</topic><topic>Intensive</topic><topic>Internal Fixators</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Models, Anatomic</topic><topic>Original Article</topic><topic>Pelvic Bones - physiopathology</topic><topic>Pelvic Bones - surgery</topic><topic>Prosthesis Failure</topic><topic>Sacrum - injuries</topic><topic>Sports Medicine</topic><topic>Studies</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mcdonald, E.</creatorcontrib><creatorcontrib>Theologis, A. A.</creatorcontrib><creatorcontrib>Horst, P.</creatorcontrib><creatorcontrib>Kandemir, U.</creatorcontrib><creatorcontrib>Pekmezci, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mcdonald, E.</au><au>Theologis, A. A.</au><au>Horst, P.</au><au>Kandemir, U.</au><au>Pekmezci, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2015-12-01</date><risdate>2015</risdate><volume>41</volume><issue>6</issue><spage>665</spage><epage>671</epage><pages>665-671</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>Purpose
This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C).
Methods
An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated.
Results
The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18–7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (
p
< 0.05). Rotation of the pubis and sacrum was not different between In-Fix constructs combined with single-level IS and TS fixation.
Conclusion
In this model of an unstable pelvic fracture (OTA 61-C), anterior fixation with an In-Fix was biomechanically superior to an anterior Ex-Fix in the setting of single-level posterior fixation. There was no biomechanical difference between the In-Fix and Ex-Fix when each was combined with two levels of posterior sacral fixation.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26038006</pmid><doi>10.1007/s00068-014-0482-8</doi><tpages>7</tpages></addata></record> |
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| issn | 1863-9933 1863-9941 |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Analysis Biomechanical Phenomena - physiology Biomechanics Bone Screws Critical Care Medicine Emergency Medicine External Fixators Fracture Fixation - instrumentation Fracture Fixation - methods Fractures Fractures, Bone - physiopathology Fractures, Bone - surgery Humans Intensive Internal Fixators Medicine Medicine & Public Health Models, Anatomic Original Article Pelvic Bones - physiopathology Pelvic Bones - surgery Prosthesis Failure Sacrum - injuries Sports Medicine Studies Surgery Surgical Orthopedics Traumatic Surgery |
| title | When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study |
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