Subscribe to RSS
DOI: 10.1055/s-0039-1697973
Are Anterior Plates More Effective than Iliosacral Screws to Fix the Sacroiliac Joint? Biomechanical Study[*]
Article in several languages: português | English
Abstract
Introduction Sacroiliac joint dislocations are caused by high energy trauma and commonly treated with the iliosacral screw fixation or the anterior plating of the sacroiliac joint (SIJ). However, there is a lack of consensus regarding which procedure is the most successful in treating sacroiliac joint dislocations. This aims to compare stiffness and maximum load of pelvises with sacroiliac joint dislocations treated with both procedures in a synthetic bone model.
Methods Synthetic pelvises were mounted and divided into 2 treatment groups (n = 5): a model with two orthogonal plates placed anteriorly to the SIJ (PPS group) and another with two iliosacral screws fixating the SIJ (SPS group), both with pubic symphysis fixation. The maximum load supported by each sample was observed and the stiffness was calculated from the curve load vs displacement. The mean values of load to failure and stiffness for each group were compared with the Mann-Whitney U test (p < 0.05 was considered significant for all analysis).
Results The mean load to failure supported by the PPS group was 940 ± 75 N and the SPS was 902 ± 56 N, with no statistical difference. The SPS group showed higher values of stiffness (68.6 ± 11.1 N/mm) with statistical significant difference in comparison to the PPS sample (50 ± 4.0 N/mm). The mode of failure was different in each group tested.
Conclusion Despite lower stiffness, the anterior plating fixation of the sacroiliac joint can be very useful when the iliosacral screw fixation cannot be performed. Further studies are necessary to observe any differences between these two procedures on the clinical and surgical setting.
* Work developed at the Laboratory of Biomaterials in Orthopedics, School of Medical Sciences, Universidade de Campinas, Campinas, SP, Brazil.
Publication History
Received: 22 February 2019
Accepted: 18 July 2019
Publication Date:
09 January 2020 (online)
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil
Referências
- 1 Kokubo Y, Oki H, Sugita D. , et al. Functional outcome of patients with unstable pelvic ring fracture. J Orthop Surg (Hong Kong) 2017; 25 (01) 2309499016684322
- 2 Dienstknecht T, Pfeifer R, Horst K. , et al. The long-term clinical outcome after pelvic ring injuries. Bone Joint J 2013; 95-B (04) 548-553
- 3 Liu Y, Wang J, Zhang Y. Occult external iliac vein injury after anterior dislocation of the sacroiliac joint in adult patient. Acta Orthop Traumatol Turc 2017; 51 (02) 169-171
- 4 Harvey-Kelly KF, Kanakaris NK, Obakponovwe O, West RM, Giannoudis PV. Quality of life and sexual function after traumatic pelvic fracture. J Orthop Trauma 2014; 28 (01) 28-35
- 5 Zhang L, Peng Y, Du C, Tang P. Biomechanical study of four kinds of percutaneous screw fixation in two types of unilateral sacroiliac joint dislocation: a finite element analysis. Injury 2014; 45 (12) 2055-2059
- 6 Giráldez-Sánchez MA, Lázaro-Gonzálvez Á, Martínez-Reina J. , et al. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury 2015; 46 (02) 327-332
- 7 Miller AN, Routt Jr ML. Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg 2012; 20 (01) 8-16
- 8 Chen W, Pan ZJ, Chen JS. Biomechanical research on anterior double-plate fixation for vertically unstable sacroiliac dislocations. Orthop Surg 2009; 1 (02) 127-131
- 9 Zhang R, Yin Y, Li S, Hou Z, Jin L, Zhang Y. Percutaneous sacroiliac screw versus anterior plating for sacroiliac joint disruption: A retrospective cohort study. Int J Surg 2018; 50 (01) 11-16
- 10 Simpson LA, Waddell JP, Leighton RK, Kellam JF, Tile M. Anterior approach and stabilization of the disrupted sacroiliac joint. J Trauma 1987; 27 (12) 1332-1339
- 11 Routt Jr ML, Meier MC, Kregor PJ, Mayo KA. Percutaneous iliosacral screws with the patient supine technique. Oper Tech Orthop 1993; 3: 35-45
- 12 Dienstknecht T, Berner A, Lenich A. , et al. Biomechanical analysis of a transiliac internal fixator. Int Orthop 2011; 35 (12) 1863-1868
- 13 Mullis BH, Sagi HC. Minimum 1-year follow-up for patients with vertical shear sacroiliac joint dislocations treated with iliosacral screws: does joint ankylosis or anatomic reduction contribute to functional outcome?. J Orthop Trauma 2008; 22 (05) 293-298
- 14 Dujardin FH, Hossenbaccus M, Duparc F, Biga N, Thomine JM. Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma 1998; 12 (03) 145-150 , discussion 150–151
- 15 Wu T, Chen W, Zhang Q. , et al. Biomechanical Comparison of Two Kinds of Internal Fixation in a Type C Zone II Pelvic Fracture Model. Chin Med J (Engl) 2015; 128 (17) 2312-2317
- 16 von Keudell A, Tobert D, Rodriguez EK. Percutaneous fixation in pelvic and acetabular fractures: understanding evolving indication and contra- indications. Oper Tech Orthop 2015; 25: 248-255
- 17 Alla SR, Roberts CS, Ojike NI. Vascular risk reduction during anterior surgical approach sacroiliac joint plating. Injury 2013; 44 (02) 175-177
- 18 Elmanawy M, Elshoura S, Youssef S, Salama F. Treatment of sacroiliac joint disruption with anterior stabilization. Egypt Orthop J 2015; 50 (01) 45-50
- 19 Elzohairy MM, Salama AM. Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions. Orthop Traumatol Surg Res 2017; 103 (02) 223-227
- 20 van Zwienen CMA, van den Bosch EW, Snijders CJ, Kleinrensink GJ, van Vugt AB. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma 2004; 18 (09) 589-595
- 21 Vigdorchik JM, Jin X, Sethi A. , et al. A biomechanical study of standard posterior pelvic ring fixation versus a posterior pedicle screw construct. Injury 2015; 46 (08) 1491-1496
- 22 Bai Z, Gao S, Liu J, Liang A, Yu W. Anatomical evidence for the anterior plate fixation of sacroiliac joint. J Orthop Sci 2018; 23 (01) 132-136
- 23 Sagi HC, Ordway NR, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma 2004; 18 (03) 138-143
- 24 Varga E, Hearn T, Powell J, Tile M. Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. Injury 1995; 26 (02) 75-80
- 25 Sobhan MR, Abrisham SM, Vakili M, Shirdel S. Spinopelvic fixation of sacroiliac joint fractures and fracture- dislocations: A clinical 8 years follow- up study. Arch Bone Jt Surg 2016; 4 (04) 381-386
- 26 van Arkel RJ, Jeffers JRT. In vitro hip testing in the International Society of Biomechanics coordinate system. J Biomech 2016; 49 (16) 4154-4158