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The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared with External Fixation.
J Bone Joint Surg Am 2019; 101(19):1724-1731JB

Abstract

BACKGROUND

Subcutaneous fixation of the anterior pelvic ring is an emerging surgical technique for trauma patients. The aim of this study was to biomechanically evaluate 2 internal fixation devices for stabilizing a disrupted pelvic ring and compare them with traditional external fixation.

METHODS

Thirty-six synthetic pelvises with a simulated unstable ring fracture (anteroposterior compression type III) were divided into 3 groups. Group A underwent fixation with a supra-acetabular external fixator; group B, with an internal fixator using the USS II polyaxial system; and group C, with an internal fixator using the Click'X polyaxial system. Biomechanical testing included measurement of peak-to-peak displacement at 300, 400, and 500 N; total displacement; plastic deformation; stiffness; and fracture-line displacement.

RESULTS

Statistical analysis of all measured parameters revealed no significant differences among the groups. However, vertical displacement of the preshaped connecting rod within the screw heads occurred as a result of inadequate stability of the internal fixation at the rod-screw interface.

CONCLUSIONS

Although internal fixator devices are placed close to the bone and should therefore maintain greater stiffness, our data did not support the hypothesis of superior stability. Special attention is required when using a curved connecting rod as the rod is easily displaced, placing relevant anatomical structures at risk. These devices require further refinement to avoid potential patient injury.

Authors+Show Affiliations

Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31577677

Citation

Jordan, Martin C., et al. "The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared With External Fixation." The Journal of Bone and Joint Surgery. American Volume, vol. 101, no. 19, 2019, pp. 1724-1731.
Jordan MC, Brems AC, Heintel T, et al. The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared with External Fixation. J Bone Joint Surg Am. 2019;101(19):1724-1731.
Jordan, M. C., Brems, A. C., Heintel, T., Jansen, H., Hoelscher-Doht, S., & Meffert, R. H. (2019). The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared with External Fixation. The Journal of Bone and Joint Surgery. American Volume, 101(19), pp. 1724-1731. doi:10.2106/JBJS.18.01363.
Jordan MC, et al. The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared With External Fixation. J Bone Joint Surg Am. 2019 Oct 2;101(19):1724-1731. PubMed PMID: 31577677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared with External Fixation. AU - Jordan,Martin C, AU - Brems,Anna-Christina, AU - Heintel,Timo, AU - Jansen,Hendrik, AU - Hoelscher-Doht,Stefanie, AU - Meffert,Rainer H, PY - 2019/10/3/entrez PY - 2019/10/3/pubmed PY - 2019/10/3/medline SP - 1724 EP - 1731 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 101 IS - 19 N2 - BACKGROUND: Subcutaneous fixation of the anterior pelvic ring is an emerging surgical technique for trauma patients. The aim of this study was to biomechanically evaluate 2 internal fixation devices for stabilizing a disrupted pelvic ring and compare them with traditional external fixation. METHODS: Thirty-six synthetic pelvises with a simulated unstable ring fracture (anteroposterior compression type III) were divided into 3 groups. Group A underwent fixation with a supra-acetabular external fixator; group B, with an internal fixator using the USS II polyaxial system; and group C, with an internal fixator using the Click'X polyaxial system. Biomechanical testing included measurement of peak-to-peak displacement at 300, 400, and 500 N; total displacement; plastic deformation; stiffness; and fracture-line displacement. RESULTS: Statistical analysis of all measured parameters revealed no significant differences among the groups. However, vertical displacement of the preshaped connecting rod within the screw heads occurred as a result of inadequate stability of the internal fixation at the rod-screw interface. CONCLUSIONS: Although internal fixator devices are placed close to the bone and should therefore maintain greater stiffness, our data did not support the hypothesis of superior stability. Special attention is required when using a curved connecting rod as the rod is easily displaced, placing relevant anatomical structures at risk. These devices require further refinement to avoid potential patient injury. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/31577677/The_Anterior_Subcutaneous_Pelvic_Ring_Fixator:_No_Biomechanical_Advantages_Compared_with_External_Fixation L2 - http://dx.doi.org/10.2106/JBJS.18.01363 DB - PRIME DP - Unbound Medicine ER -