Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis.
Journal
Communications medicine
ISSN: 2730-664X
Titre abrégé: Commun Med (Lond)
Pays: England
ID NLM: 9918250414506676
Informations de publication
Date de publication:
22 Dec 2022
22 Dec 2022
Historique:
received:
20
07
2022
accepted:
06
12
2022
entrez:
22
12
2022
pubmed:
23
12
2022
medline:
23
12
2022
Statut:
epublish
Résumé
Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage. To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility. We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation. We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation. Life-threatening pelvic injuries are often associated with disruption of a joint within the hip bones, called the pubic symphysis. Disruption can lead to a gap and subsequent instability of the pelvis. The current treatment is to stabilize the joint with a steel plate and screws, however this often becomes unstable soon after the operation. In this study, we analyzed two alternatives for stabilization that use cables and clamps instead of the plate. Further, we tested a surgical approach for implantation. The cables and clamps were as stable as a steel plate so offer an alternative approach to stabilize the pubic symphysis.
Sections du résumé
BACKGROUND
BACKGROUND
Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage.
METHODS
METHODS
To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility.
RESULTS
RESULTS
We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation.
CONCLUSION
CONCLUSIONS
We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation.
Life-threatening pelvic injuries are often associated with disruption of a joint within the hip bones, called the pubic symphysis. Disruption can lead to a gap and subsequent instability of the pelvis. The current treatment is to stabilize the joint with a steel plate and screws, however this often becomes unstable soon after the operation. In this study, we analyzed two alternatives for stabilization that use cables and clamps instead of the plate. Further, we tested a surgical approach for implantation. The cables and clamps were as stable as a steel plate so offer an alternative approach to stabilize the pubic symphysis.
Autres résumés
Type: plain-language-summary
(eng)
Life-threatening pelvic injuries are often associated with disruption of a joint within the hip bones, called the pubic symphysis. Disruption can lead to a gap and subsequent instability of the pelvis. The current treatment is to stabilize the joint with a steel plate and screws, however this often becomes unstable soon after the operation. In this study, we analyzed two alternatives for stabilization that use cables and clamps instead of the plate. Further, we tested a surgical approach for implantation. The cables and clamps were as stable as a steel plate so offer an alternative approach to stabilize the pubic symphysis.
Identifiants
pubmed: 36550296
doi: 10.1038/s43856-022-00227-z
pii: 10.1038/s43856-022-00227-z
pmc: PMC9780275
doi:
Types de publication
Journal Article
Langues
eng
Pagination
164Subventions
Organisme : Deutsche Forschungsgemeinschaft (German Research Foundation)
ID : JO1467/2-1
Informations de copyright
© 2022. The Author(s).
Références
J Am Acad Orthop Surg. 2021 Oct 1;29(19):811-819
pubmed: 34478415
PLoS One. 2017 Nov 27;12(11):e0184000
pubmed: 29176772
Unfallchirurgie. 1991 Oct;17(5):247-52
pubmed: 1962367
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3711-3719
pubmed: 33693977
J Am Acad Orthop Surg. 2012 Feb;20(2):86-93
pubmed: 22302446
J Bone Joint Surg Am. 2020 Sep 2;102(17):1542-1550
pubmed: 32358411
Injury. 2016 Aug;47(8):1707-12
pubmed: 27282685
Clin Orthop Relat Res. 2012 Aug;470(8):2148-53
pubmed: 22552765
Clin Biomech (Bristol, Avon). 2020 Jul;77:105009
pubmed: 32454345
J Orthop Trauma. 2018 Feb;32 Suppl 1:S18-S24
pubmed: 29373447
BMC Musculoskelet Disord. 2015 May 28;16:127
pubmed: 26018203
J Orthop Trauma. 2017 Jan;31(1):27-30
pubmed: 27755336
Injury. 2022 Feb;53(2):519-522
pubmed: 34620470
Unfallchirurgie. 1991 Dec;17(6):335-42
pubmed: 1767454
J Orthop Surg Res. 2016 May 27;11(1):62
pubmed: 27233837
Injury. 2013 Feb;44(2):183-8
pubmed: 23068141
J Clin Med. 2021 Oct 28;10(21):
pubmed: 34768569
J Am Acad Orthop Surg. 2014 Feb;22(2):111-20
pubmed: 24486757
Int Orthop. 2013 Jan;37(1):125-30
pubmed: 23142812
Injury. 2011 Oct;42(10):1012-9
pubmed: 21232742
J Clin Med. 2021 May 26;10(11):
pubmed: 34073570
Injury. 2018 Nov;49(11):1993-1998
pubmed: 30241733
Clin Orthop Relat Res. 1994 Dec;(309):245-56
pubmed: 7994968
Med Sci Sports Exerc. 2010 Oct;42(10):1819-25
pubmed: 20305579
J Orthop Trauma. 2020 Nov;34(11):578-582
pubmed: 33065657
JBJS Case Connect. 2019 Jul-Sep;9(3):e0075
pubmed: 31469666
J Orthop Trauma. 2015 Jun;29(6):290-4
pubmed: 25470564
Obstet Gynecol. 2007 Mar;109(3):701-6
pubmed: 17329523
Mater Sci Eng C Mater Biol Appl. 2019 Sep;102:844-862
pubmed: 31147056
Orthop Res Rev. 2016 Oct 14;8:57-66
pubmed: 30774470
Acta Orthop Belg. 2013 Feb;79(1):54-9
pubmed: 23547516
Clin Orthop Relat Res. 2014 Aug;472(8):2338-42
pubmed: 24867452
Clin Orthop Relat Res. 2012 Aug;470(8):2154-60
pubmed: 22707071
Prog Urol. 2001 Dec;11(6):1306-13
pubmed: 11859672
Surg Technol Int. 2016 Oct 26;29:265-269
pubmed: 27466875
J Orthop Res. 2016 Mar;34(3):369-85
pubmed: 26488900
Injury. 2022 Feb;53(2):339-345
pubmed: 34895919
J Orthop Trauma. 2002 Feb;16(2):99-103
pubmed: 11818804
Unfallchirurg. 2020 Nov;123(11):870-878
pubmed: 32347368
Biomed Eng Lett. 2020 Oct 26;10(4):505-516
pubmed: 33194244
Unfallchirurg. 1998 Jan;101(1):18-25
pubmed: 9522667
Injury. 1995 Mar;26(2):75-80
pubmed: 7721471
J Gen Intern Med. 2011 Feb;26(2):192-6
pubmed: 20857339
J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170
pubmed: 29256945
Arch Orthop Trauma Surg. 2023 Jun;143(6):3111-3117
pubmed: 35831608
Unfallchirurgie. 1985 Oct;11(5):223-7
pubmed: 4071834
Acta Orthop Scand. 1970;41(4):446-53
pubmed: 5502409
J Orthop Trauma. 1997 Nov;11(8):590-3
pubmed: 9415866
Clin Biomech (Bristol, Avon). 2022 May;95:105652
pubmed: 35489167
Injury. 1990 Jul;21(4):223-4
pubmed: 2228193
J Bone Joint Surg Br. 2011 Feb;93(2):237-44
pubmed: 21282765
Arch Orthop Trauma Surg. 2022 Sep;142(9):2235-2243
pubmed: 34052913
Arch Orthop Trauma Surg. 2012 Feb;132(2):265-70
pubmed: 22139387
J Orthop Trauma. 2012 Jul;26(7):402-6
pubmed: 22183199
Sci Rep. 2021 Jun 29;11(1):13463
pubmed: 34188088
J Orthop Trauma. 2010 Oct;24(10):610-5
pubmed: 20871248
OTA Int. 2021 Apr 15;4(2 Suppl):
pubmed: 37608858
J Bone Joint Surg Am. 2009 Jul;91(7):1630-6
pubmed: 19571085
J Bone Joint Surg Br. 2011 Jan;93(1):78-84
pubmed: 21196548
Biomed Eng Online. 2019 Mar 29;18(1):38
pubmed: 30925898
J Biomech. 2014 Jan 22;47(2):380-6
pubmed: 24290178