Motion preservation for open book injuries of the pubic symphysis -a biomechanical cadaver study.

Biomechanics Flexible osteosynthesis Minimally invasive Pelvic instability Pubic symphysis SpeedBridge™

Journal

Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043

Informations de publication

Date de publication:
27 May 2024
Historique:
received: 23 01 2024
accepted: 17 05 2024
medline: 27 5 2024
pubmed: 27 5 2024
entrez: 27 5 2024
Statut: aheadofprint

Résumé

Open book injuries are challenging injuries that oftentimes require surgical treatment. Currently, treatment is performed with symphyseal plating requiring extensive surgery and entirely limiting physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a minimally invasive tape suture construct (modified SpeedBridge™) as an alternative stabilization technique for the treatment of open book injuries in human cadaver pelvic rings. The symphysis of 9 human cadaver pelvises was dissected and dilated to 3 cm creating an open book injury. Next, the two osteosynthesis methods (plating, modified SpeedBridge™) were applied. All specimens then underwent cyclic horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, 3D dislocation (mm) was calculated. Total displacement (mm) of the pubic symphysis displayed the following means and standard deviations: native group 1.34 ± 0.62 mm, open book group 3.01 ± 1.26 mm, tape group 1.94 ± 0.59 mm and plate group 1.37 ± 0.41 mm. Comparison between native and open book (p = 0.029), open book and plate (p = 0.004), open book and tape (p = 0.031), as well as tape and plate group (p = 0.002) showed significant differences. No significant differences were found when comparing the native and tape (p = 0.059), as well as the native and plate (p = 0.999) group. While both osteosynthesis techniques sufficiently stabilized the injury, symphyseal plating displayed the highest rigidity. The modified SpeedBridge™ as a tape suture construct provided statistically sufficient biomechanical stability while maintaining symphyseal micro mobility, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis.

Identifiants

DOI: 10.1007/s00402-024-05390-7 PMID: 38801533
pubmed: 38801533
doi: 10.1007/s00402-024-05390-7
pii: 10.1007/s00402-024-05390-7
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

Références

Culemann UOHPT (2014) Aktuelle Behandlung Der Beckenringfraktur. Unfallchirurg 145–161
Harrasser N, Eisenhart-Rothe R, Biberthaler P (2016) Facharztwissen Orthopädie Unfallchirurgie
Alton TB, Gee AO (2014) Classifications in brief: Young and Burgess classification of pelvic ring injuries. Clin Orthop Relat Res 472
Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160:445–451. https://doi.org/10.1148/radiology.160.2.3726125
doi: 10.1148/radiology.160.2.3726125 pubmed: 3726125
Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium - 2007. J Orthop Trauma 21:S1–S6. https://doi.org/10.1097/00005131-200711101-00001
doi: 10.1097/00005131-200711101-00001 pubmed: 18277234
Baqué P, Trojani C, Delotte J et al (2005) Anatomical consequences of open-book pelvic ring disruption. A cadaver experimental study. Surg Radiol Anat 27:487–490. https://doi.org/10.1007/s00276-005-0027-2
doi: 10.1007/s00276-005-0027-2 pubmed: 16311717
Bühren V, Keel MJB, Marzi I (2016) Checkliste Traumatologie
Wright RD (2018) Indications for Open Reduction Internal fixation of Anterior Pelvic Ring disruptions. J Orthop Trauma 32:S18–S23. https://doi.org/10.1097/BOT.0000000000001252
doi: 10.1097/BOT.0000000000001252 pubmed: 30095677
Jordan MC, Jäckle V, Scheidt S et al (2020) Ergebnisse Nach Plattenstabilisierung Der Symphysensprengung. Unfallchirurg 123:870–878. https://doi.org/10.1007/s00113-020-00804-8
doi: 10.1007/s00113-020-00804-8 pubmed: 32347368 pmcid: 7653790
Collinge C, Archdeacon MT, Dulaney-Cripe E, Moed BR (2012) Radiographic Changes of Implant failure after plating for Pubic Symphysis Diastasis: an underappreciated reality? Clin Orthop Relat Res 470:2148–2153. https://doi.org/10.1007/s11999-012-2340-5
doi: 10.1007/s11999-012-2340-5 pubmed: 22552765 pmcid: 3392370
Eastman JG, Krieg JC, Routt MLC (2016) Early failure of symphysis pubis plating. Injury 47:1707–1712. https://doi.org/10.1016/j.injury.2016.05.019
doi: 10.1016/j.injury.2016.05.019 pubmed: 27282685
Walheim G, Olerud S, Ribbe T (1984) Mobility of the pubic symphysis: measurements by an electromechanical method. Acta Orthop Scand 55:203–208. https://doi.org/10.3109/17453678408992338
doi: 10.3109/17453678408992338 pubmed: 6545936
Moed BR, Grimshaw CS, Segina DN (2012) Failure of locked design-specific plate fixation of the Pubic Symphysis. J Orthop Trauma 26:e71–e75. https://doi.org/10.1097/BOT.0b013e31822c8396
doi: 10.1097/BOT.0b013e31822c8396 pubmed: 22183198
Chen L, Ouyang Y, Huang G et al (2013) Endobutton technique for dynamic fixation of traumatic symphysis pubis disruption. Acta Orthop Belg 79:54–59
pubmed: 23547516
Nuber S, Ovalle D, Förch S et al (2019) Die Dreipunktabstützung mittels Fixateur interne zur minimalinvasiven Stabilisierung Des Vorderen Beckenrings. Unfallchirurg 122:870–879. https://doi.org/10.1007/s00113-018-0599-z
doi: 10.1007/s00113-018-0599-z pubmed: 30617539
Scheyerer MJ, Zimmermann SM, Osterhoff G et al (2014) Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes 7:133. https://doi.org/10.1186/1756-0500-7-133
doi: 10.1186/1756-0500-7-133 pubmed: 24606833 pmcid: 3975274
Regauer M, Mackay G, Lange M et al (2017) Syndesmotic InternalBrace(TM) for anatomic distal tibiofibular ligament augmentation. World J Orthop 8:301–309. https://doi.org/10.5312/wjo.v8.i4.301
doi: 10.5312/wjo.v8.i4.301 pubmed: 28473957 pmcid: 5396014
Chauhan A, Regal S, Frank DA (2014) Hybrid repair of large Crescent Rotator Cuff tears using a modified SpeedBridge and Double-Pulley Technique. Arthrosc Tech 3:e409–e412. https://doi.org/10.1016/j.eats.2014.04.001
doi: 10.1016/j.eats.2014.04.001 pubmed: 25126513 pmcid: 4130136
Gilmer BB, Crall T, DeLong J et al (2016) Biomechanical Analysis of Internal Bracing for Treatment of Medial Knee Injuries. Orthopedics 39:e532–e537. https://doi.org/10.3928/01477447-20160427-13
doi: 10.3928/01477447-20160427-13 pubmed: 27135459
Cavalcanti Kußmaul A, Schwaabe F, Kistler M et al (2021) Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study. Arch Orthop Trauma Surg 142:2235–2243. https://doi.org/10.1007/s00402-021-03968-z
doi: 10.1007/s00402-021-03968-z pubmed: 34052913 pmcid: 9381629
Cavalcanti Kußmaul A, Schwaabe F, Kistler M et al (2022) Tape suture constructs for instabilities of the pubic symphysis: is the idea of motion preservation a suitable treatment option? A cadaver study. Arch Orthop Trauma Surg 143:3111–3117. https://doi.org/10.1007/s00402-022-04547-6
doi: 10.1007/s00402-022-04547-6 pubmed: 35831608 pmcid: 10192136
Putnis SE, Pearce R, Wali UJ et al (2011) Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis. J Bone Joint Surg Br 93–B:78–84. https://doi.org/10.1302/0301-620X.93B1.23941
doi: 10.1302/0301-620X.93B1.23941
Jordan MC, Jäckle V, Scheidt S Outcome after plate stabilization of symphyseal diastasis. Unfallchirurg 123:870–878. https://doi.org/10.1007/s00113-020-00804-8
Schwaabe F, Gleich J, Linhart C, et al (2021) How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-021-01850-6
Cavalcanti Kußmaul A, Schwaabe F, Becker CA, et al (2022) Does augmentation increase the pull-out force of symphyseal screws? A biomechanical cadaver study. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-022-01963-6
Jordan MC, Jäckle V, Scheidt S et al (2021) Trans-Obturator cable fixation of open book pelvic injuries. Sci Rep 11:13463. https://doi.org/10.1038/s41598-021-92755-2
doi: 10.1038/s41598-021-92755-2 pubmed: 34188088 pmcid: 8241833
Jordan MC, Bröer D, Fischer C et al (2022) Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis. Commun Med 2:164. https://doi.org/10.1038/s43856-022-00227-z
doi: 10.1038/s43856-022-00227-z pubmed: 36550296 pmcid: 9780275
Kiskaddon EM, Wright A, Meeks BD et al (2018) A biomechanical cadaver comparison of suture button fixation to plate fixation for pubic symphysis diastasis. Injury 49:1993–1998. https://doi.org/10.1016/j.injury.2018.09.032
doi: 10.1016/j.injury.2018.09.032 pubmed: 30241733
Xu Y, Kang R, Li M et al (2022) The clinical efficacy of suture-button fixation and trans-syndesmotic screw fixation in the treatment of Ankle Fracture Combined with Distal Tibiofibular Syndesmosis Injury: a retrospective study. J Foot Ankle Surg 61:143–148. https://doi.org/10.1053/j.jfas.2021.07.009
doi: 10.1053/j.jfas.2021.07.009 pubmed: 34404589
Rommens PM, Arand C, Thomczyk S et al (2019) [Fragility fractures of the pelvis]. Unfallchirurg 122:469–482. https://doi.org/10.1007/s00113-019-0643-7
doi: 10.1007/s00113-019-0643-7 pubmed: 30980097
Arnold AS, Anderson FC, Pandy MG, Delp SL (2005) Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait. J Biomech 38:2181–2189. https://doi.org/10.1016/j.jbiomech.2004.09.036
doi: 10.1016/j.jbiomech.2004.09.036 pubmed: 16154404

Auteurs

Adrian Cavalcanti Kußmaul (A)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. adrian.kussmaul@med.uni-muenchen.de.
ORCID: 0000-0002-9648-0998

Nele Baur (N)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Jan Wulf (J)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Axel Greiner (A)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Rouven Neudeck (R)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Manuel Kistler (M)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Carl Neuerburg (C)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Wolfgang Böcker (W)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Christopher A Becker (CA)

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Classifications MeSH