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Biomechanische Grundlagen bei osteoporotischer Frakturversorgung am Becken

Biomechanical principles for treatment of osteoporotic fractures of the pelvis

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Zusammenfassung

Frakturen des Beckens bei Vorliegen einer Osteoporose gewinnen zunehmend an Bedeutung. Sie stellen den Chirurgen aufgrund der häufig verminderten Knochenqualität vor Probleme.

Im Rahmen dieser Übersicht werden die Studienergebnisse relevanter biomechanischer Arbeiten für instabile Beckenringfrakturen und die vorliegenden Arbeiten zur Biomechanik von Osteosynthesen bei Azetabulumfrakturen diskutiert.

Abstract

Fractures of the pelvis are of increasing interest, especially in older patients due to the often concomitant osteoporosis. The low bone quality can be a problem in several fixation situations.

In this review the present and relevant literature on biomechanical data of unstable pelvic ring injuries and all biomechanical data dealing with osteosynthesis for acetabular fractures are discussed.

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Literatur

  1. Albert M, Miller M, MacNaughton M, Hutton W (1993) Posterior pelvic fixation using a transiliac 4.5 mm reconstruction plate: a clinical and biomechanical study. J Orthop Trauma 7(3):226–232

    Article  CAS  PubMed  Google Scholar 

  2. Anglen J, Burd T, Hendricks K, Harrison P (2003) The „gull sign“. A harbinger of failure for internal fixation of geriatric acetabular fractures. J Orthop Trauma 17:625–634

    Article  PubMed  Google Scholar 

  3. Berner W (1986) Biomechanische Untersuchungen am Sakroiliakalgelenk, Topographie, Beanspruchung und operative Stabilisierung. Habilitationsschrift, Hannover

  4. Berner W, Tscherne H (1986) Biomechanik der dorsalen und ventralen Osteosynthese des Sacroiliacalgelenkes. Hefte Unfallheilkd 181:627–631

    Google Scholar 

  5. Böhler J (1953) Experimentelle Untersuchungen über die Ursache der sog. Kopfnekrose nach Verrenkungen und Verrenkungsbrüchen des Hüftgelenkes. Chirurg 24:344–349

    PubMed  Google Scholar 

  6. Brown T, Stone J, Schuster J, Mears D (1982) External fixation of unstable pelvic ring fractures: comparative rigidity of some current frame configurations. Med Biol Eng Comput 20:727–733

    Article  CAS  PubMed  Google Scholar 

  7. Chang JK, Gill SS, Zura RD et al (2001) Comparative strength of three methods of fixation of transverse acetabular fractures. Clin Orthop (392):433–441

    Google Scholar 

  8. Comstock C, van der Meulen M, Marjolein C, Goodman S (1996) Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. Clin Orthop 10:517–522

    CAS  Google Scholar 

  9. Culemann U, Pohlemann T (2008) Beckenverletzungen. In: Raschke MJ, Stange R (Hrsg) Alterstraumatologie, Kap 13. Elsevier, München, S 286–304

  10. Culemann U, Pohlemann T, Hufner T, Gänsslen A (2000) 3-dimensional movement analysis after internal fixation of pelvic ring fractures. A computer simulation. Unfallchirurg 103(11):965–971

    Article  CAS  PubMed  Google Scholar 

  11. Culemann U, Seelig M, Lange U et al (2007) Vergleichende biomechanische Untersuchung zur internen Stabilisierung der transforaminalen Sakrumfraktur: Ist eine winkelstabile Plattenosteosynthese vorteilhaft? Unfallchirurg 110(6):528–536

    Article  CAS  PubMed  Google Scholar 

  12. Daum W, Pattersen R, Cartwright T, Viegas S (1991) Comparison of cortical and cancellous screw pull-out strengths about the posterior column and sacroiliac joint. J Orthop Trauma 5(1):34–37

    Article  CAS  PubMed  Google Scholar 

  13. Ecke H, Burger H, Hofmann D et al (1984) Stabilitätsprüfung verschiedener Osteosyntheseverfahren nach Symphysenruptur und Sprengung der Ileosacralfuge. Langenbecks Arch Chir 3:195–199

    Google Scholar 

  14. Gänsslen A, Hüfner T, Krettek C (2006) Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy. Oper Orthop Traumatol 18:225–244

    Article  PubMed  Google Scholar 

  15. Gänsslen A, Pohlemann T, Paul C et al (1996) Epidemiology of pelvic ring injuries. Injury [suppl 1, part 1]:13–20

  16. Gay B, Roman W, Arbogast R (1984) Makroskopische und mikroskopische Veränderungen am Femurkopf nach Acetabulumfrakturen. Hefte Unfallheilkd 164:663–669

    Google Scholar 

  17. Gay B, Romen W (1983) Makroskopische und mikroskopische Befunde am Femurkopf nach Acetabulumfraktur. Unfallheilkunde 86:201–204

    CAS  PubMed  Google Scholar 

  18. Gorczyca J, Varga E, Woodside T et al (1996) The strength of iliosacral lag screw and transiliac bars in the fixation of vertically unstable pelvic injuries with sacral fractures. Injury 27(8):561–564

    Article  CAS  PubMed  Google Scholar 

  19. Goulet J et al (1994) Comminuted fractures of the posterior wall of the acetabulum. A biomechanical evaluation of fixation methods. J Bone Joint Surg 76-A:1457–1463

    Google Scholar 

  20. Greenwald A, O’Connor J (1971) The transmission of load through the human hip joint. J Biomech 4:507–528

    Article  CAS  PubMed  Google Scholar 

  21. Hak DJ, Hamel AJ, Bay BK et al (1998) Consequences of transverse acetabular fracture malreduction on load transmission across the hip joint. J Orthop Trauma 12(2):90–100

    Article  CAS  PubMed  Google Scholar 

  22. Hearn T, Schopfer A, D’Angelo D, Tile M (1991) The effects of ligament sectioning and internal fixation on bending stiffness of the pelvic ring. Proceedings of the 13th International conference on biomechanics, Perth, Australia

  23. Helfet D, Borelli J, DiPasquale T, Sanders R (1992) Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg 74-A(5):753–765

    Google Scholar 

  24. Hofmann D (1991) Vergleichende Untersuchung verschiedener Stabilisierungsverfahren bei der Luxation der Beckenhalbgelenke. Unfallchirurgie 17(5):247–252

    Article  CAS  PubMed  Google Scholar 

  25. Hofmann D, Ecke H, Burger H et al (1985) Festigkeitsuntersuchung verschiedener Osteosyntheseverfahren bei Symphysenruptur und Sprengung der Iliosacralfuge. Hefte Unfallheilkd 174:75–78

    Google Scholar 

  26. Jacob A, Messmer P, Stock K et al (1997) Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol 20:285–294

    Article  CAS  PubMed  Google Scholar 

  27. Kannus P, Palvanen M, Niemi S et al (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int 11:443–448

    Article  CAS  PubMed  Google Scholar 

  28. Kannus P, Palvanen M, Parkkari J et al (2005) Osteoporotic pelvic fractures in elderly women. Osteoporos Int 16:1304–1305

    Article  PubMed  Google Scholar 

  29. Konrath GA, Hamel AJ, Guerin J et al (1999) Biomechanical evaluation of impaction fractures of the femoral head. J Orthop Trauma 13(6):407–413

    Article  CAS  PubMed  Google Scholar 

  30. Konrath GA, Hamel AJ, Sharkey NA et al (1998) Biomechanical evaluation of a low anterior wall fracture: correlation with the CT subchondral arc. J Orthop Trauma 12(3):152–158

    Article  CAS  PubMed  Google Scholar 

  31. Konrath GA, Hamel AJ, Sharkey NA et al (1998) Biomechanical consequences of anterior column fracture of the acetabulum. J Orthop Trauma 12(8):547–552

    Article  CAS  PubMed  Google Scholar 

  32. Kraemer W, Hearn T, Tile M, Powell J (1994) The effect of thread length and location on extraction strengths of iliosacral lag screws. Injury 25(1):5–9

    Article  CAS  PubMed  Google Scholar 

  33. Kraus E, Schlickewei W, Cordey J et al (1998) Methode zur vergleichenden Messung der Stabilität von Osteosynthesen am dorsalen Beckenring. Unfallchirurg 24(1):25–31

    CAS  Google Scholar 

  34. Krüger P, Euler E, Raderschadt M et al (1986) Vergleichende experimentelle und klinische Untersuchungen verschiedener stabilisierender Osteosynthesetechniken im dorsalen Beckenbereich. Hefte Unfallheilkd 181:625–626

    Google Scholar 

  35. Lansinger O, Karlsson J, Berg U, Mare K (1984) Unstable fractures of the pelvis treated with a trapezoid compression frame. Acta Orthop Scand 55:325–329

    CAS  PubMed  Google Scholar 

  36. Leighton R, Waddell J, Bray T et al (1991) Biomechanical testing of new and old fixation devices for vertical shear fractures of the pelvis. J Orthop Trauma 5(3):313–317

    Article  CAS  PubMed  Google Scholar 

  37. Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer, Berlin Heidelberg New York

  38. Levine RG, Renard R, Behrens FF, Tornetta P 3rd (2002) Biomechanical consequences of secondary congruence after both-column acetabular fracture. J Orthop Trauma 16(2):87–91

    Article  PubMed  Google Scholar 

  39. Lindahl J, Hirvensalo E (2005) Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop 76(5):667–678

    Article  PubMed  Google Scholar 

  40. Lindahl J, Hirvensalo E, Bostman O, Santavirta S (1999) Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg [Br] 81(6):955–962

    Google Scholar 

  41. Malkani A, Voor M, Rennirt G et al (1996) Increased peak pressure following incongruent reduction of transverse acetabular fractures. A cadaveric model. 12th Annual Meeting, OTA, Boston

  42. Mast J, Jacob R, Ganz R (1989) Planning and reduction techniques in fracture surgery. Springer, Berlin Heidelberg New York

  43. McBroom R, Tile M (1982) Disruption of the pelvic ring. Orthop Trans 6:493

    Google Scholar 

  44. Mears D, Capito C, Deleeuw H (1988) Posterior pelvic disruptions managed by the use of the double cobra plate. AAOS Instr Course Lect 37:143–150

    CAS  Google Scholar 

  45. Mears D, Rubash H (1984) External and internal fixation of the pelvic ring. AAOS Instr Course Lect 33:144–158

    CAS  Google Scholar 

  46. Olson S, Bay B, Chapman M, Sharkey N (1995) Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg 77-A:1184–1192

    Google Scholar 

  47. Olson S, Bay B, Hamel A (1997) Biomechanics of the hip joint and the effects of fracture of the acetabulum. Clin Orthop 339:92–104

    Article  PubMed  Google Scholar 

  48. Olson S, Bay B, Pollak A et al (1996) The effect of variable size posterior wall acetabular fractures on contact characteristics of the hip joint. J Orthop Trauma 10(6):395–402

    Article  CAS  PubMed  Google Scholar 

  49. OTA (1996) Fracture and dislocation compendium. J Orthop Trauma 10 [suppl 1]:71–75

  50. Pagenkopf E, Grose A, Partal G, Helfet D (2006) Acetabular fractures in the elderly: treatment recommendations. HSSJ 2:161–171

    Article  Google Scholar 

  51. Pohlemann T, Angst M, Schneider E et al (1993) Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma 7(2):107–117

    Article  CAS  PubMed  Google Scholar 

  52. Pohlemann T, Culemann U, Tscherne H (1992) Vergleichende biomechanische Untersuchungen zur internen Stabilisierung der transforaminalen Sakrumfraktur. Orthopäde 21:413–421

    CAS  PubMed  Google Scholar 

  53. Pohlemann T, Gänsslen A, Hartung S für die Arbeitsgruppe Becken (1998) Beckenverletzungen/Pelvic Injuries. Results of the German Multicenter Study Group. Hefte zu „Der Unfallchirurg“. Springer, Berlin Heidelberg New York

  54. Rieger H (1996) Das instabile Becken, Diagnostik, Therapie und Prognose der Beckenringfraktur. Zuckschwerdt, München Bern Wien New York

  55. Rieger H, Wetterkamp D, Schröder-Schlüter J (1994) Osteotaxis bei Beckenringverletzung. Hefte zu „Der Unfallchirurg“ 241:241–248

  56. Rieger H, Winckler S, Wetterkamp D, Overbeck J (1996) Clinical and biomechanical aspects of external fixation of the pelvis. Clin Biomech 11(6):322–327

    Article  Google Scholar 

  57. Rubash H, Brown T, Nelson D, Mears D (1983) Comperative mechanical performance of some new devices for fixation of unstable pelvic ring fractures. Med Biol Eng Comput 21:657–663

    Article  CAS  PubMed  Google Scholar 

  58. Sagi HC, Ordway NR, DiPasquale T (2004) Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma 18(3):138–143

    Article  CAS  PubMed  Google Scholar 

  59. Sahlstrand T (1979) Disruption of the pelvic ring treated by the external skeletal fixation. JBJS 61-A:433–434

  60. Sar C, Kilicoglu O (2003) S1 pediculoiliac screw fixation in instabilities of the sacroiliac complex: biomechanical study and report of two cases. J Orthop Trauma 17(4):262–270

    Article  PubMed  Google Scholar 

  61. Sawaguchi T, Brown T, Rubash H, Mears D (1984) Stability of acetabular fractures after internal fixation- a cadaveric study. Acta Orthop Scand 55:601–605

    Article  CAS  PubMed  Google Scholar 

  62. Schildhauer TA, Ledoux WR, Chapman JR et al (2003) Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 17(1):22–31

    Article  PubMed  Google Scholar 

  63. Schopfer A, DiAngelo D, Hearn T et al (1994) Biomechanical comparison of methods of fixation of isolated osteotomies of the posterior acetabular column. Int Orthop 18:96–101

    Article  CAS  PubMed  Google Scholar 

  64. Shaw J, Eng M, Mino D et al (1985) Posterior stabilisation of pelvic fractures by use of threated compression rods. Clin Orthop 192:240–254

    PubMed  Google Scholar 

  65. Shazar N, Brumback R, Novak V, Belkoff S (1998) Biomechanical evaluation of transverse acetabular fracture fixation. Clin Orthop 352:215–222

    PubMed  Google Scholar 

  66. Simonian P, Routt M, Harrington R, Tencer A (1995) The acetabular T-type fracture: a biomechanical evaluation of internal fixation. Clin Orthop 314:234–240

    PubMed  Google Scholar 

  67. Simonian P, Routt M, Harrington R, Tencer A (1997) The unstable iliac fracture: a biomechanical evaluation of internal fixation. Injury 28(7):469–475

    Article  CAS  PubMed  Google Scholar 

  68. Simonian PT, Routt ML Jr, Harrington RM et al (1994) Biomechanical simulation of the anteroposterior compression injury of the pelvis. An understanding of instability and fixation. Clin Orthop (309):245–256

    Google Scholar 

  69. Stocks G, Gablel D, Noble P et al (1991) Anterior and posterior internal fixation of vertical shear fractures of the pelvis. J Orthop Res 9:237–245

    Article  CAS  PubMed  Google Scholar 

  70. Tile M (1984) Fractures of the pelvis and acetabulum. Williams & Wilkings, Baltimore

  71. Tile M (1995) Fractures of the pelvis and acetabulum, 2nd edn. Williams & Wilkings, Baltimore

  72. Tile M, Helfet D, Kellam J (2003) Fractures of the pelvis and acetabulum. Lippincott Williams & Wilkins, Baltimore

  73. Tsiridis E, Upadhyay N, Giannoudis P (2006) Sacral insufficiency fractures: current concepts of management. Osteoporos Int 17:1716–1725

    Article  CAS  PubMed  Google Scholar 

  74. Van Zwienen CM, van den Bosch EW, Hoek van Dijke GA et al (2005) Cyclic loading of sacroiliac screws in Tile C pelvic fractures. J Trauma 58(5):1029–1034

    Article  Google Scholar 

  75. Van Zwienen CM, van den Bosch EW, Snijders CJ et al (2004) Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma 18(9):589–595

    Article  Google Scholar 

  76. Varga E, Hearn T, Powell J, Tile M (1995) Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. Injury 26(2):75–80

    Article  CAS  PubMed  Google Scholar 

  77. Von Eisenhart-Rothe R, Witte H, Steinlechner M et al (1999) Quantitative determination of pressure distribution in the hip joint during the gait cycle. Unfallchirurg 102(8):625–631

    Article  Google Scholar 

  78. Yinger K, Scalise J, Olson SA et al (2003) Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma 17(7):481–487

    Article  PubMed  Google Scholar 

  79. Zoys GN, McGanity PL, Lanctot DR et al (1999) Biomechanical evaluation of fixation of posterior acetabular wall fractures. J South Orthop Assoc 8(4):254–260; discussion 260

    CAS  PubMed  Google Scholar 

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  1. Klinik für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223, Celle, Deutschland

    A. Gänsslen

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Gänsslen, A. Biomechanische Grundlagen bei osteoporotischer Frakturversorgung am Becken. Unfallchirurg 113, 272–280 (2010). https://doi.org/10.1007/s00113-010-1763-2

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