Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 2/2016

01-04-2016 | Original Article

Symphyseal internal rod fixation versus standard plate fixation for open book pelvic ring injuries: a biomechanical study

Authors: G. Osterhoff, S. Tiziani, C. Hafner, S. J. Ferguson, H.-P. Simmen, C. M. L. Werner

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2016

Login to get access

Abstract

Purpose

This study investigates the biomechanical stability of a novel technique for symphyseal internal rod fixation (SYMFIX) using a multiaxial spinal screw-rod implant that allows for direct reduction and can be performed percutaneously and compares it to standard internal plate fixation of the symphysis.

Methods

Standard plate fixation (PLATE, n = 6) and the SYMFIX (n = 6) were tested on pelvic composite models with a simulated open book injury using a universal testing machine. On a previously described testing setup, 500 consecutive cyclic loadings were applied with sinusoidal resulting forces of 200 N. Displacement under loading was measured using an optoelectronic camera system and construct rigidity was calculated as a function of load and displacement.

Results

The rigidity of the PLATE construct was 122.8 N/mm (95 % CI: 110.7–134.8), rigidity of the SYMFIX construct 119.3 N/mm (95 % CI: 105.8–132.7). Displacement in the symphyseal area was mean 0.007 mm (95 % CI: 0.003–0.012) in the PLATE group and 0.021 mm (95 % CI: 0.011–0.031) in the SYMFIX group. Displacement in the sacroiliac joint area was mean 0.156 mm (95 % CI: 0.051–0.261) in the PLATE group and 0.120 mm (95 % CI: 0.039–0.201) in the SYMFIX group.

Conclusions

In comparison to standard internal plate fixation for the stabilization of open book pelvic ring injuries, symphyseal internal rod fixation using a multiaxial spinal screw-rod implant in vitro shows a similar rigidity and comparable low degrees of displacement.
Literature
1.
Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329–38.CrossRefPubMedPubMedCentral
2.
Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.CrossRefPubMed
3.
Rüedi T, Buckley R, Moran C. AO principles of fracture management, vol. 2. 2nd ed. NewYork: Thieme; 2007.
4.
Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg. 1988;70B:1–12.
5.
Putnis SE, Pearce R, Wali UJ, Bircher MD, Rickman MS. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis: one-year radiological and functional outcomes. J Bone Joint Surg Br. 2011;93(1):78–84.CrossRefPubMed
6.
Adams MR, Scolaro JA, Routt ML Jr. The pubic midline exposure for symphyseal open reduction and plate fixation. J Orthop Traumatol Off J Italian Soc Orthop Traumatol. 2014;15:195–9.CrossRef
7.
Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury. 2011;42(10):992–6.CrossRefPubMed
8.
Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36(5):599–604.CrossRefPubMed
9.
Kuttner M, Klaiber A, Lorenz T, Fuchtmeier B, Neugebauer R. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg. 2009;112(7):661–9.CrossRefPubMed
10.
Osterhoff G, Tiziani S, Ferguson SJ, Spreiter G, Scheyerer MJ, Spinas GL, Wanner GA, Simmen HP, Werner CM. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation. BMC Musculoskelet Disord. 2014;15:111.CrossRefPubMedPubMedCentral
11.
Scheyerer MJ, Zimmermann SM, Osterhoff G, Tiziani S, Simmen HP, Wanner GA, Werner CM. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes. 2014;7:133.CrossRefPubMedPubMedCentral
12.
Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma. 2012;26(1):1–8.CrossRefPubMed
13.
Vaidya R, Kubiak EN, Bergin PF, Dombroski DG, Critchlow RJ, Sethi A, Starr AJ. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012;470(8):2124–31.CrossRefPubMedPubMedCentral
14.
Ferguson SJ, Winkler F, Nolte LP. Anterior fixation in the osteoporotic spine: cut-out and pullout characteristics of implants. Eur Spine J. 2002;11(6):527–34.CrossRefPubMed
15.
Meissner A, Fell M, Wilk R, Boenick U, Rahmanzadeh R. Biomechanics of the pubic symphysis. Which forces lead to mobility of the symphysis in physiological conditions? Unfallchirurg. 1996;99(6):415–21.PubMed
16.
Clements JP, Moriaty N, Chesser TJ, Ward AJ, Cunningham JL. Determination of pelvic ring stability: a new technique using a composite hemi-pelvis. Proc Inst Mech Eng H. 2008;222(5):611–6.CrossRefPubMed
17.
Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Onwudiwe NA, Vaidya R. Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX) vs External Fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res. 2012;7(1):31.CrossRefPubMedPubMedCentral
18.
Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Vaidya R. Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone. Int Orthop. 2013;37(7):1341–6.CrossRefPubMedPubMedCentral
19.
Dupont WD, Plummer WD. Power and sample size calculations for studies involving linear regression. Control Clin Trials. 1998;19:589–601.CrossRefPubMed
20.
Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One. 2013;8(10):e77807.CrossRefPubMedPubMedCentral
21.
Giraldez-Sanchez MA, Lazaro-Gonzalvez A, Martinez-Reina J, Serrano-Toledano D, Navarro-Robles A, Cano-Luis P, Fragkakis EM, Giannoudis PV. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury. 2014;46:327–32.CrossRefPubMed
22.
van Zwienen CM, van den Bosch EW, van Hoek Dijke GA, Snijders CJ, van Vugt AB. Cyclic loading of sacroiliac screws in Tile C pelvic fractures. J Trauma. 2005;58(5):1029–34.CrossRefPubMed
23.
Chong AC, Miller F, Buxton M, Friis EA. Fracture toughness and fatigue crack propagation rate of short fiber reinforced epoxy composites for analogue cortical bone. J Biomech Eng. 2007;129(4):487–93.CrossRefPubMed
24.
Osterhoff G, Baumgartner D, Favre P, Wanner GA, Gerber H, Simmen HP, Werner CM. Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg. 2011;20(5):740–6.CrossRefPubMed
25.
Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res. 1996;329:88–96.CrossRefPubMed
26.
Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma. 2008;22(6):373–8.CrossRefPubMed
27.
Cappuccio M, Amendola L, Paderni S, Bosco G, Scimeca G, Mirabile L, Gasbarrini A, De Iure F. Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures. Orthopedics. 2013;36(6):e729–34.CrossRefPubMed
28.
Ringel F, Stoffel M, Stuer C, Meyer B. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery. 2006;59(4 Suppl 2):ONS361–6 (discussion ONS366–367).PubMed
Metadata
Title
Symphyseal internal rod fixation versus standard plate fixation for open book pelvic ring injuries: a biomechanical study
Authors
G. Osterhoff
S. Tiziani
C. Hafner
S. J. Ferguson
H.-P. Simmen
C. M. L. Werner
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0529-5

Other articles of this Issue 2/2016

European Journal of Trauma and Emergency Surgery 2/2016 Go to the issue

Review Article

From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment

Original Article

Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation

Review Article

Portable ultrasound in disaster triage: a focused review

Original Article

Segway® related injuries in Vienna: report from the Lorenz Böhler Trauma Centre

Editorial

Advancing clinician-performed sonography in the twenty-first century: building on the rich legacy of the twentieth century pioneers

Original Article

A multicentre cross-sectional study to examine physicians’ ability to rule out a distal radius fracture based on clinical findings