Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis

Miguel A Giráldez-Sánchez; Ángel Lázaro-Gonzálvez; Javier Martínez-Reina; David Serrano-Toledano; Alfredo Navarro-Robles; Pedro Cano-Luis; Evangelos M Fragkakis; Peter V Giannoudis

doi:10.1016/j.injury.2014.10.058

Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis

Injury. 2015 Feb;46(2):327-32. doi: 10.1016/j.injury.2014.10.058. Epub 2014 Nov 1.

Authors

Miguel A Giráldez-Sánchez¹, Ángel Lázaro-Gonzálvez¹, Javier Martínez-Reina², David Serrano-Toledano³, Alfredo Navarro-Robles², Pedro Cano-Luis¹, Evangelos M Fragkakis⁴, Peter V Giannoudis⁴

Affiliations

¹ Clinical Orthopaedics, Trauma Surgery and Rheumatology Management Unit, Hospital Universitario Virgen del Rocío, Seville, Spain.
² Department of Mechanical Engineering, University of Seville, Escuela Superior de Ingenieros, Seville, Spain.
³ Clinical Orthopaedics, Trauma Surgery and Rheumatology Management Unit, Hospital Universitario Virgen del Rocío, Seville, Spain. Electronic address: serranotoledano@gmail.com.
⁴ Academic Department of Trauma and Orthopaedics, Clarendon Wing, Level A, Leeds General Infirmary Great George Street, LS1 3EX Leeds, UK.

PMID: 25554422
DOI: 10.1016/j.injury.2014.10.058

Abstract

Introduction: Although the gold standard in open book pelvic fractures remains the pubic symphysis (PS) plate fixation, the clinical outcomes are not satisfactory, despite the excellent anatomical reduction assessed radiologically. Some authors suggest that residual instability of the posterior pelvic elements may be responsible for the chronic pain and the early osteoarthritic changes in the sacroiliac joint (SIJ).

Objective: To evaluate whether the isolated posterior fixation with one or two iliosacral screws (ISSs) is sufficient to provide adequate stability for the treatment of Burgess Young APC-II (YB APC-II) type of pelvic ring injuries.

Methods: Biomechanical experimental study using 7 fresh human pelvises, where an YB APC-II pelvic injury was previously implemented. The isolated posterior fixation of the pelvic ring with 1 or 2 ISSs directed in the S1 vertebra body was analysed in each specimen following an axial load of 300N. The different displacement of the SIJ and of the PS were analysed in all three spatial axes, using the validated optical measurement system 3D PONTOS 5M. A multivariate version of Friedman test (non-parametric ANOVA for repeated measures) was performed.

Results: The isolated fixation of the SIJ with 1 ISS did not show any differences with respect to the intact pelvis (p=0.851). Regarding the PS, both type of fixations (with 1 or 2 ISSs) confirmed an acceptable correction and adequate control of the PS even though with some differences compared to the intact pelvis (p=0.01). The presence of the second ISS found not to offer any significant additional benefit. The three-dimensional analysis of the behaviour of the pelvic elements, in these two different types of fixation, did not show any statistical significant differences (p=0.645).

Conclusion: The posterior fixation with ISS can represent an alternative option for treatment of pelvic injuries associated with rotational instability. Further prospective clinical studies are necessary to determine, the influence of the residual pubic symphysis mobility in the every day life, when the above-mentioned technique is applied.

Keywords: Biomechanic; Minimally invasive fixation; Open-book fracture; Pelvis; Screw; Young-Burgess fracture.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biomechanical Phenomena
Bone Plates
Bone Screws
Cadaver
Female
Fracture Fixation, Internal / methods*
Fractures, Bone / pathology
Fractures, Bone / surgery*
Humans
Pelvic Bones / injuries
Pelvic Bones / pathology
Pelvic Bones / surgery*
Pubic Symphysis / pathology
Pubic Symphysis / surgery*
Sacrum / injuries
Sacrum / pathology
Sacrum / surgery*