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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2015 | Original Article

Supplemental S1 fixation for type C pelvic ring injuries: biomechanical study of a long iliosacral versus a transsacral screw

Authors: Pooria Salari, Berton R. Moed, J. Gary Bledsoe

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2015

Abstract

Background

A single iliosacral screw placed into the S1 vertebral body has been shown to be clinically unreliable for certain type C pelvic ring injuries. Insertion of a second supplemental iliosacral screw into the S1 or S2 vertebral body has been widely used. However, clinical fixation failures have been reported using this technique, and a supplemental long iliosacral or transsacral screw has been used. The purpose of this study was to compare the biomechanical effect of a supplemental S1 long iliosacral screw versus a transsacral screw in an unstable type C vertically oriented sacral fracture model.

Materials and methods

A type C pelvic ring injury was created in ten osteopenic/osteoporotic cadaver pelves by performing vertical osteotomies through zone 2 of the sacrum and the ipsilateral pubic rami. The sacrum was reduced maintaining a 2-mm fracture gap to simulate a closed-reduction model. All specimens were fixed using one 7.0-mm iliosacral screw into the S1 body. A supplemental long iliosacral screw was placed into the S1 body in five specimens. A supplemental transsacral S1 screw was placed in the other five. Each pelvis underwent 100,000 cycles at 250 N, followed by loading to failure. Vertical displacements at 25,000, 50,000, 75,000, and 100,000 cycles and failure force were recorded.

Results

Vertical displacement increased significantly (p < 0.05) within each group with each increase in the number of cycles. However, there was no statistically significant difference between groups in displacement or load to failure.

Conclusions

Although intuitively a transsacral screw may seem to be better than a long iliosacral screw in conveying additional stability to an unstable sacral fracture fixation construct, we were not able to identify any biomechanical advantage of one method over the other.

Level of evidence

Does not apply—biomechanical study.

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Title: Supplemental S1 fixation for type C pelvic ring injuries: biomechanical study of a long iliosacral versus a transsacral screw
Authors: Pooria Salari
Berton R. Moed
J. Gary Bledsoe
Publication date: 01-12-2015
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2015
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-015-0357-8

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Supplemental S1 fixation for type C pelvic ring injuries: biomechanical study of a long iliosacral versus a transsacral screw

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

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