Journal article
A biomechanical comparison of superior ramus plating versus intramedullary screw fixation for unstable lateral compression pelvic ring injuries
Injury, v 53(12), pp 3899-3903
Dec 2022
PMID: 36182593
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
•Repairs of the superior ramus were tested in vitro with either screw or plate fixation.•Cyclic loading with an average head, arms and trunk load of 400 N followed by cylces with 800 N of axial loading were applied to the whole pelvis in single leg support.•Repair with a screw provided lower translational and angular displacements across the rami fractures than plate fixation with the angular displacement statistically significantly different.
Management of the anterior component of unstable lateral compression (LC) pelvic ring injuries remains controversial. Common internal fixation options include plating and superior pubic ramus screws. These constructs have been evaluated in anterior-posterior compression (APC) fracture patterns, but no study has compared the two for unstable LC patterns, which is the purpose of this study.
A rotationally unstable LC pelvic ring injury was modeled in 10 fresh frozen cadaver specimens by creating a complete sacral fracture, disruption of posterior ligaments, and ipsilateral superior and inferior rami osteotomies. All specimens were repaired posteriorly with two fully threaded 7 mm cannulated transiliac-transsacral screws through the S1 and S2 corridors. The superior ramus was repaired with either a 3.5 mm pelvic reconstruction plate (n = 5) or a bicortical 5.5 mm cannulated retrograde superior ramus screw (n = 5). Specimens were loaded axially in single leg support for 1000 cycles at 400 N followed by an additional 3 cycles at 800 N. Displacement and angulation of the superior and inferior rami osteotomies were measured with a three-dimensional (3D) motion tracker. The two fixation methods were then compared with Mann-Whitney U-Tests.
Retrograde superior ramus screw fixation had lower average displacement and angulation than plate fixation in all categories, with the motion at the inferior ramus at 800 N of loading showing a statistically significant difference in angulation.
Although management of the anterior ring in unstable LC injuries remains controversial, indications for fixation are becoming more defined over time. In this study, the 5.5 mm cannulated retrograde superior ramus screw significantly outperformed the 3.5 mm reconstruction plate in angulation of the inferior ramus fracture at 800 N. No other significance was found, however the ramus screw demonstrated lower average displacements and angulations in all categories for both the inferior and superior ramus fractures.
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Details
- Title
- A biomechanical comparison of superior ramus plating versus intramedullary screw fixation for unstable lateral compression pelvic ring injuries
- Creators
- Eric C. Hempen - Allegheny Health NetworkBenjamin M. Wheatley - Allegheny Health NetworkPatrick J. Schimoler - University of PittsburghAlexander Kharlamov - Allegheny Health NetworkPatricia R. Melvin - Allegheny Health NetworkMark Carl Miller - University of PittsburghGregory T. Altman - Allegheny Health NetworkDaniel T. Altman - Allegheny Health NetworkEdward R. Westrick - Allegheny Health Network
- Publication Details
- Injury, v 53(12), pp 3899-3903
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiology (Radiologic Sciences); Orthopedic/Orthopaedic Surgery
- Web of Science ID
- WOS:000975287900008
- Scopus ID
- 2-s2.0-85139032645
- Other Identifier
- 991021897302704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Emergency Medicine
- Orthopedics
- Surgery