Stability of internal versus external fixation in osteoporotic pelvic fractures - a biomechanical analysis.
External fixator
Fragility fracture of the pelvis
Internal fixator
Osteoporosis
Pelvic ring injury
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
24
08
2019
revised:
22
07
2020
accepted:
09
08
2020
pubmed:
18
8
2020
medline:
22
6
2021
entrez:
18
8
2020
Statut:
ppublish
Résumé
Osteoporosis-related fragility fractures of the pelvic ring (FFP) differ fundamentally from pelvic fractures in younger patients. However, very little is known about biomechanical stability of different osteosynthesis procedures addressing the anterior pelvic ring in these fractures. The aim of this study was to compare standard external fixation with internal fixation using a novel screw-and-rod system in osteoporotic fractures of the pelvic ring in terms of stiffness, plastic deformation and maximum load under cyclic loading in a human cadaveric model. A total of 18 embalmed osteoporotic cadaver pelvis specimens were randomized based on the T-score into a group for external fixation and a group for internal fixation. FFP type-IIB fractures were created. In addition to the external or internal fixator, a cement-augmented sacroiliac screw was implanted. Afterwards, axial cyclic loading was performed in a testing setup simulating one-leg stand. Mean plastic deformation and stiffness both were significantly better in the internal fixation group than in the external fixation group (plastic deformation: 0.37 mm (SD: 0.23) versus 0.71 mm (SD: 0.26), p = 0.011; stiffness: 43.69 N/mm (SD: 18.39) versus 26.52 N/mm (SD: 9.76), p = 0.029). Maximum load did not differ significantly between internal fixator (506.3 N; SD: 129.4) and external fixator (461.1 N; SD: 147.4) (p = 0.515). Submuscular internal fixation might be an interesting alternative to external fixation in clinical practice because of better biomechanical properties as well as several advantages in clinical use.
Identifiants
pubmed: 32800315
pii: S0020-1383(20)30689-6
doi: 10.1016/j.injury.2020.08.017
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
2460-2464Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no conflict of interest regarding this work. No money was paid to the authors or their institution. No funding for research was received. Ludwig Oberkircher does advisory and lecture activities for Medtronic, Spineart, Vexim, DFine Inc. and K2M.