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Boháč P, Apostolopoulos V, Marcián P, Tomáš T, Mahdal M, Návrat T. Computational modeling of bone allograft reconstruction following femoral shaft tumor resection: Investigating the impact of supplementary plate fixation. PLoS One 2025; 20:e0316719. [PMID: 39913461 PMCID: PMC11801617 DOI: 10.1371/journal.pone.0316719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 12/15/2024] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND AND OBJECTIVE The use of bone allograft reconstructions after tumor resection can introduce significant complications. Stable fixation is required to decrease the incidence of mechanical complications of segmental bone allografts. The purpose of the present study is to compare plating fixation methods of diaphyseal allografts after intercalary resection of the femur. METHODS We created four defined fixation models using plates and/or intramedullary polymethylmethacrylate (PMMA) to simulate typical bone tumor resection with intercalary allograft reconstruction. One angularly stable plate (DFP) with 13 locking screws and fresh frozen allografts (labeled "I") were used for bone reconstruction. Three modified reconstructions were created: "II" included a supplementary plate (SP) with four locking screws, "III" was augmented with intramedullary PMMA in the allograft, and "IV" combined intramedullary PMMA and both plates. We applied a load model that simulates partial weight bearing on the lower limb to simulate the load during postoperative rehabilitation. RESULTS The highest stress in the DFP occurred at the allograft-bone transition, with variant IV reaching 297 MPa. PMMA augmentation reduced median interfragmentary motion (IFM) and sliding distances, with variant III achieving the lowest distal sliding distance (0.9 μm) in the distal area. Supplementary plate fixation reduced maximal and median proximal IFM distances (86.9 μm in variant II vs. 116.0 μm in variant I) but increased sliding distances (23.7 μm in variant II vs. 0.6 μm in variant I). CONCLUSIONS PMMA augmentation reduces IFM and sliding distances, enhancing rigidity, particularly in the distal area. Supplementary plate fixation decreases IFM distances in the proximal area but increases sliding distances in the same region. Variants III and IV demonstrate lower IFM and sliding distances in the distal area overall. Variant III shows very low sliding distances in both distal and proximal areas. Variant IV combines improved firmness with slightly higher stress levels.
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Affiliation(s)
- Petr Boháč
- Faculty of Mechanical Engineering, Institute of Solid Mechanics, Mechatronics and Biomechanics, University of Technology, Brno, Czech Republic
| | - Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Marcián
- Faculty of Mechanical Engineering, Institute of Solid Mechanics, Mechatronics and Biomechanics, University of Technology, Brno, Czech Republic
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Návrat
- Faculty of Mechanical Engineering, Institute of Solid Mechanics, Mechatronics and Biomechanics, University of Technology, Brno, Czech Republic
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Wu H, Sun Z, Shen Q, Wu X, Li C, Cai X. Biomechanical simulation of bed turning post-acetabular fracture fixation. Sci Rep 2025; 15:2014. [PMID: 39815081 PMCID: PMC11735941 DOI: 10.1038/s41598-025-86653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 01/13/2025] [Indexed: 01/18/2025] Open
Abstract
Before patients begin out-of-bed exercises following internal fixation surgery for acetabular fractures, turning over in bed serves as a crucial intervention to mitigate complications associated with prolonged bed rest. However, data on the safety of this maneuver post-surgery are limited, and the biomechanical evidence remains unclear. This study aims to introduce a novel loading protocol designed to preliminarily simulate the action of turning over in bed and to compare the biomechanical properties of two fixation methods for acetabular fractures under this new protocol. A RNJ-500 microcomputer-controlled electronic torsion tester was utilized to simulate the action of turning over in bed and to conduct a dynamic torsion loading test. Initially, the torque values and torsional stiffness of six intact pelvis specimens (Group A) were measured. A double-column acetabular fracture model was then created and stabilized using two different fixation methods: the Dynamic Anterior Plate-Screw System for the Quadrilateral plate (DAPSQ, Group B) and the traditional anterior reconstruction titanium plate plus a 1/3 tubular buttress plate (Group C). All specimens underwent cyclic torsion loading ranging from 2° to 8°. The medial displacement and strain values of the quadrilateral plate were recorded and analyzed. As the torsion angles increased from 2° to 8°, Groups A and B exhibited significantly higher torque values compared to Group C (all P < 0.05). Group C demonstrated notably lower torsional stiffness (1.51 ± 0.20) relative to Group A (2.33 ± 0.25, P < 0.05) and Group B (2.21 ± 0.29, P < 0.05). Additionally, the medial displacement of the quadrilateral plate was significantly reduced in Group B compared to Group C at all measured time points (P < 0.05). And Group C exhibited significantly higher maximum tensile and compressive strain than Group B (all P < 0.05). The DAPSQ plate with quadrilateral screws provides superior anti-rotational stability in a double-column acetabular fracture model under the newly established torsion loading protocol.
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Affiliation(s)
- Haiyang Wu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Zaijie Sun
- Department of Orthopaedic Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qixiao Shen
- Department of Orthopaedic Surgery, Yangxin People's Hospital, Yangxin, 435200, Hubei, China
| | - Xuejian Wu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Cheng Li
- Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China.
- Center for Musculoskeletal Surgery (CMSC), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany.
| | - Xianhua Cai
- Department of Orthopaedic, South China Hospital of Shenzhen University, Shenzhen, 518116, Guangdong, China.
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430064, Hubei, China.
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Bannister DA, Yong TM, Morris CA, Collinge CA, Mitchell PM. Pathoanatomy of the anterior column-posterior hemitransverse acetabular fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 35:10. [PMID: 39567398 DOI: 10.1007/s00590-024-04122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 10/26/2024] [Indexed: 11/22/2024]
Abstract
PURPOSE To define the pathoanatomy of the anterior column-posterior hemitransverse (ACPHT) subtype of acetabulum fractures and assess the morphologic variation therein. METHODS Retrospective cohort study including 50 patients age greater than 60 with an ACPHT acetabular fracture managed operatively over an 11-year period at an ACS Level 1 Trauma center. Cross-sectional CT images were reviewed for anterior column/wall comminution, anterior column fracture exit point, completeness of the anterior column and posterior column fractures, articular impaction and quadrilateral surface continuity with the posterior column. RESULTS Comminution of the anterior column/wall was seen in 60% of patients. The anterior column fracture line exit was variable and exited below the anterior inferior iliac spine (AIIS) in 36% of fractures, at the AIIS or between the iliac spines in 40%, and through the iliac crest in 24%. A complete fracture was present in 72% of anterior column fractures and 44% of posterior column fractures. Impaction of the acetabular joint surface was present in 84% of patients. Continuity of the quadrilateral surface with the posterior column was present in 60% of cases. CONCLUSIONS Significant variability exists within the ACPHT fracture pattern. Understanding the variability within the ACPHT subtype is critical for adequately analyzing these patterns and has implications in future biomechanical studies and implant design. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Dalton A Bannister
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA
| | - Taylor M Yong
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA
| | - Cade A Morris
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA
| | - Cory A Collinge
- Department of Orthopedic Trauma, Harris Methodist Fort Worth Hospital, Fort Worth, TX, 76104, USA
| | - Phillip M Mitchell
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA.
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Andrzejewski K, Domzalski M, Rokita B, Poszepczynski J, Komorowski P. Effectiveness of Virtual Surgical Planning and Three-Dimensional Anatomical Models in Radiological Reconstruction of Center of Rotation and Pelvic Brim in Patients with Anterior Column Defects Requiring Revision Hip Arthroplasty. Diagnostics (Basel) 2024; 14:2574. [PMID: 39594240 PMCID: PMC11592446 DOI: 10.3390/diagnostics14222574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 11/02/2024] [Accepted: 11/07/2024] [Indexed: 11/28/2024] Open
Abstract
Background: The aim of this study was to show that virtual surgical planning (VSP) and printed anatomical models support the reconstruction of the center of rotation (COR) and pelvic BRIM during revision hip surgery using a dual-mobility revision cup system in patients with anterior pelvic column damage and soft tissue envelope deficiency. Methods: Patients with anterior pelvic column damage and soft tissue envelope deficiency underwent revision hip arthroplasty. Virtual planning included assessment of bone segmentation, positioning of the cementless revision cup while maintaining the COR, and the assumed inclination and anteversion angles. Results: The diameter of the planned revision cups was 65.5 ± 2.1 mm, and the diameter of the revision cups used was 65.3 ± 2.1 mm. The difference in COR position in the horizontal axis was 7.8 ± 9.3 mm, in the vertical axis was 4.3 ± 5.9 mm, and in the axial plane was 1.6 ± 3.3 mm. The differences in inclination angle and in the anteversion angle were 12.4° and 8.7°, respectively. Conclusions: The use of VSP and 3D models supports the process of performing RHA surgery in patients with damage to the anterior pelvic column and soft tissue envelope deficiency.
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Affiliation(s)
- Krzysztof Andrzejewski
- Veteran’s Memorial Hospital Medical, University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; (K.A.); (M.D.); (J.P.)
| | - Marcin Domzalski
- Veteran’s Memorial Hospital Medical, University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; (K.A.); (M.D.); (J.P.)
| | - Bozena Rokita
- Institute of Applied Radiation Chemistry, Faculty of Chemistry, Lodz University of Technology, Wroblewskiego 15, 93-590 Lodz, Poland;
| | - Jan Poszepczynski
- Veteran’s Memorial Hospital Medical, University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; (K.A.); (M.D.); (J.P.)
| | - Piotr Komorowski
- Division of Biophysics, Institute of Materials Science, Lodz University of Technology, Stefanowskiego 1/15, 90-924 Lodz, Poland
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Wang W, Cai X, Liu X, Wang G, Kang H, Qian S. Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach. Front Surg 2024; 11:1438036. [PMID: 39328841 PMCID: PMC11424611 DOI: 10.3389/fsurg.2024.1438036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Background Managing complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. Traditional implants do not provide sufficient fixed strength or a proper match. The new-type pre-contoured infrapectineal buttress plates may have drawbacks, such as inaccurate fitting on the medial surface of QLP and an inability to apply reversed compression force to resist medial displacement of femoral head. Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures. Methods We conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19-73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d'Aubigné and Harris Hip scores (HHS). Results The patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). At the final follow-up, no re-protrusion of the femoral head was observed. In terms of functional outcome, the mean modified Merle d'Aubigné-Postel score was excellent in 26 patients (54.17%), good in 17 patients (35.42%), fair in four patients (8.33%), and poor in one patient (2.08%). The HHS was excellent in 23 patients (47.92%), good in 20 patients (41.67%), fair in four patients (8.33%), and poor in one patient (2.08%). The average HHS was 87.38 ± 7.86 (ranging from 52 to 98). Postoperative complications included lateral femoral cutaneous nerve injury in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. Late complications were observed in two patients, with one case of heterotopic ossification and another case of post-traumatic osteoarthritis underwent hip arthroplasty within two years after surgery. Conclusion Our results indicate that employing the contoured plate specifically designed for QLP injuries, in conjunction with quadrilateral screws through the ilioinguinal approach, can lead to positive outcomes in the treatment of displaced acetabular fractures involving the QLP. This straightforward and efficient technique offers a viable option for surgeons who are managing complex acetabular fractures.
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Affiliation(s)
- Wei Wang
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
- Department of Orthopedic Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine), Wuhan, China
| | - Xianhua Cai
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
- Department of Orthopedic Surgery, South China Hospital of Shenzhen University, Shenzhen, China
| | - Ximing Liu
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Guodong Wang
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Hui Kang
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Shenglong Qian
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
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Wu YD, Mei XZ, Wu WF, Zhang HX, Liang J, Cai XH. Experimental study on the biomechanical stability of complex acetabular fractures in the quadrilateral area: application of a dynamic anterior titanium-plate screw system. BMC Musculoskelet Disord 2024; 25:526. [PMID: 38982393 PMCID: PMC11232251 DOI: 10.1186/s12891-024-07646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Complex acetabular fractures involving quadrilateral areas are more challenging to treat during surgery. To date, there has been no ideal internal fixation for these acetabular fractures. The purpose of this study was to evaluate the biomechanical stability of complex acetabular fractures using a dynamic anterior titanium-plate screw system of the quadrilateral area (DAPSQ) by simulating the standing and sitting positions of pelvic specimens. MATERIALS AND METHODS Eight formal in-preserved cadaveric pelvises aged 30-50 years were selected as the research objects. First, one hip of the normal pelvises was randomly used as the control model (group B) for measurement, and then one hip of the pelvises was randomly selected to make the fracture model in the 8 intact pelvises as the experimental model (group A) for measurement. In group A, acetabular both-column fractures in the quadrilateral area were established, and the fractures were fixed by DAPSQ. The biomechanical testing machine was used to load (simulated physiological load) from 400 N to 700 N at a 1 mm/min speed for 30 s in the vertical direction when the specimens were measured at random in simulated standing or sitting positions in groups. The horizontal displacement and longitudinal displacement of the acetabular fractures in the quadrilateral area were measured in both the standing and sitting simulations. RESULTS As the load increased, no dislocation or internal fixation breakage occurred during the measurements. In the standing position, the horizontal displacement of the quadrilateral area fractures in group A and group B appeared to be less than 1 mm with loads ranging from 400 N to 700 N, and there was no significant difference between group A and group B (p > 0.05). The longitudinal displacement appeared to be greater than 1 mm with a load of 700 mm in group A (700 N, 2 cases), and the difference was significant between group A and group B (p < 0.05). In the sitting position, the horizontal and longitudinal displacements of the quadrilateral areas were within 0.5 mm in group A and group B, and there was no significant difference between group A and group B (p > 0.05). CONCLUSION For complex acetabular fractures in the quadrilateral area, DAPSQ fixation may provide early sitting stability, but it is inappropriate for patients to stand too early.
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Affiliation(s)
- Yong-De Wu
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China
| | - Xian-Zhong Mei
- Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital, Shenzhen, China
| | - Wei-Fei Wu
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China
| | - Hong-Xi Zhang
- Department of Mechanical Room, Wuhan University of Technology, Wuhan, China
| | - Jie Liang
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China
| | - Xian-Hua Cai
- Department of Orthopedics, South China Hospital of Shenzhen University, No.1 Fuxin Road, Longgang District, Shenzhen, Guangdong Province, 518000, China.
- Department of Orthopedics, General Hospital of Central Theater Command of The People's Liberation Army, Wuhan, China.
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Chen X, Wu H, Cheng K, Liu X, Cai X. Inclined angles of acetabular quadrilateral plate: digital measurement and clinical application of the new anatomical concept. J Orthop Surg Res 2023; 18:723. [PMID: 37749606 PMCID: PMC10518972 DOI: 10.1186/s13018-023-04143-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/27/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Matta scoring standard is one of the most frequently used postoperative imaging evaluations for acetabular fracture reduction, but has obvious shortcomings. This study, for the first time, proposed the concept of inclined angles of acetabular quadrilateral plate. The purpose of this study was to investigate the normal range of the inclined angles in adults by digital measurement and explore the feasibility of using them to evaluate the reduction quality of acetabular quadrilateral fractures after surgery. METHODS Firstly, the pelvic CT three-dimensional reconstruction data of 40 healthy adults including 20 males and 20 females were collected. The normal range of the anterior, middle, and posterior inclined angles were measured via Mimics software. Secondly, a modified Matta criteria that combined the classic Matta criteria and evaluation criteria of the inclined angles was proposed. And we classified modified Matta criteria into three grades including excellent, good and poor. Finally, a total of 125 cases with quadrilateral plate fractures was included and the postoperative CT data were analyzed by using both the classic Matta criteria and our modified Matta criteria. Then, the accuracy and consistency of both criteria to evaluate postoperative hip function was investigated. RESULTS The average anterior inclined angle: male (97.11° ± 2.59°), female (90.63° ± 2.09°); middle inclined angle: male (105.57° ± 1.93°), female (100.64° ± 2.46°); and posterior inclined angle: male (112.62° ± 2.54), female (106.37° ± 2.53°). Whether in males or in females, the anterior, middle, and posterior inclined angles showed a progressively increasing trend. All the three inclined angles in males were all significantly larger than those in females (p < 0.05). Among 125 cases with quadrilateral plate fractures, 101 cases (80.8%) were graded as excellent, 18 cases (14.4%) as good, and 6 cases (4.8%) as poor according to the classic Matta criteria. While based on modified Matta criteria, there were excellent in 37 cases (29.6%), good in 76 cases (60.8%), and poor in 12 cases (9.6%). According to the Harris hip score system, the functional outcomes were excellent in 59 cases (47.2%), good in 26 cases (20.8%), fair in 24 cases (19.2%), and poor in 16 cases (12.8%). Our results showed that among the cases evaluated as excellent according to the classic Matta criteria and modified Matta criteria, the excellent-to-good rates of hip function were 70.3% and 78.4%, respectively. And among the cases evaluated as poor according to the modified Matta criteria, the fair-to-poor rate of hip function was 75%, while this value was 50% for classic Matta criteria. Both differences were statistically significant (p < 0.05). CONCLUSION Inclined angles of the quadrilateral plate could be used to assess the quality of fracture reduction and provide a basis for evaluating the rotational displacement of fracture blocks in the quadrilateral plate, which compensates the shortage of classic Matta criteria.
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Affiliation(s)
- Xiaofeng Chen
- Department of Orthopaedic Surgery, Yangxin People's Hospital, Yangxin, 435200, Hubei, China
| | - Haiyang Wu
- Department of Clinical Medicine, Graduate School of Tianjin Medical University, Tianjin, 301700, China.
| | - Kunming Cheng
- Department of Intensive Care Unit, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430064, Hubei, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, South China Hospital Affiliated to Shenzhen University, Shenzhen, 518111, Guangdong, China.
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Chen K, Huang G, Wan Y, Yao S, Su Y, Li L, Guo X. Biomechanical study of different fixation constructs for anterior column and posterior hemi-transverse acetabular fractures: a finite element analysis. J Orthop Surg Res 2023; 18:294. [PMID: 37041549 PMCID: PMC10088117 DOI: 10.1186/s13018-023-03715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 03/15/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To compare the biomechanical properties and stability, using a finite element model, of four fixation constructs used for the treatment of anterior column and posterior hemi-transverse (ACPHT) acetabular fractures under two physiological loading conditions (standing and sitting). METHODS A finite element model simulating ACPHT acetabular fractures was created for four different scenarios: a suprapectineal plate combined with posterior column and infra-acetabular screws (SP-PS-IS); an infrapectineal plate combined with posterior column and infra-acetabular screws (IP-PS-IS); a special infrapectineal quadrilateral surface buttress plate (IQP); and a suprapectineal plate combined with a posterior column plate (SP-PP). Three-dimensional finite element stress analysis was performed on these models with a load of 700 N in standing and sitting positions. Biomechanical stress distributions and fracture displacements were analysed and compared between these fixation techniques. RESULTS In models simulating the standing position, high displacements and stress distributions were observed at the infra-acetabulum regions. The degree of these fracture displacements was low in the IQP (0.078 mm), as compared to either the IP-PS-IS (0.079 mm) or the SP & PP (0.413 mm) fixation constructs. However, the IP-PS-IS fixation construct had the highest effective stiffness. In models simulating the sitting position, high fracture displacements and stress distributions were observed at the regions of the anterior and posterior columns. The degree of these fracture displacements was low in the SP-PS-IS (0.101 mm), as compared to the IP-PS-IS (0.109 mm) and the SP-PP (0.196 mm) fixation constructs. CONCLUSION In both standing and sitting positions, the stability and stiffness index were comparable between the IQP, SP-PS-IS, and IP-PS-IS. These 3 fixation constructs had smaller fracture displacements than the SP-PP construct. The stress concentrations at the regions of quadrilateral surface and infra-acetabulum suggest that the buttressing fixation of quadrilateral plate was required for ACPHT fractures.
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Affiliation(s)
- Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Guixiong Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Yanlin Su
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China.
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Duan P, Ding X, Xiong M, Wang P, Xu S, Du W. Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis. J Orthop Surg Res 2023; 18:251. [PMID: 36973727 PMCID: PMC10044380 DOI: 10.1186/s13018-023-03736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Treatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator. METHODS A patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis. RESULTS Under the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3-13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases. CONCLUSIONS The acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.
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Affiliation(s)
- Pengyun Duan
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Xiaohong Ding
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China.
| | - Min Xiong
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Panfeng Wang
- Department of Orthopaedics, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Shipeng Xu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Wei Du
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
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10
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Asanuma K, Miyamura G, Suzuki Y, Makino Y, Takada N, Satonaka H, Yoshida K, Hagi T, Nakamura T, Sudo A. New screw technique for posterior column and ischial fixation from the anterior approach for acetabular fractures. J Surg Case Rep 2023; 2023:rjad073. [PMID: 36860356 PMCID: PMC9970693 DOI: 10.1093/jscr/rjad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/30/2023] [Indexed: 03/02/2023] Open
Abstract
Management of the ischial fragment in acetabular fractures is a considerable problem. In this report, we presented how to drill or screw around the posterior column and ischium from the anterior approach using a novel 'sleeve guide technique' and the difficulty of plating. A sleeve, drill, depth gauge and driver from DepuySynthes were prepared. The portal was about 2-3 cm inside the anterior superior iliac spine opposite to the side of the fracture. The sleeve was inserted to the screw point around quadrilateral area through the retroperitoneal space. Drilling, measuring screw length by a depth gauge and the screwing were performed through the sleeve. Case 1 used a one-third plate and case 2 used a reconstruction plate. With this technique, the approach angles to the posterior column and ischium were inclined, and plating and screw insertion could be performed with a low risk of organ injury.
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Affiliation(s)
- Kunihiro Asanuma
- Correspondence address. Department of Orthopedic Surgery, Mie University, 2-174, Edobashi, Tsu City, Mie 514-8507, Japan. Tel: +81-59-231-5022; Fax: +81-59-231-5211; E-mail:
| | - Gaku Miyamura
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | - Yoshiaki Suzuki
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | - Yoshinori Makino
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | - Naoya Takada
- Department of Orthopedic Surgery, Kainan Hospital, Yatomi, Japan
| | - Haruhiko Satonaka
- Department of Orthopedic Surgery, Ise Municipal General Hospital, Ise, Japan
| | - Kakunoshin Yoshida
- Department of Orthopedic Surgery, Ise Municipal General Hospital, Ise, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | - Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
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11
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A novel anatomical self-locking plate fixation for both-column acetabular fractures. Chin J Traumatol 2022; 25:345-352. [PMID: 35478088 PMCID: PMC9751769 DOI: 10.1016/j.cjtee.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/26/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare the stability of the posterior anatomic self-locking plate (PASP) with two types of popular reconstruction plate fixation, i.e. double reconstruction plate (DRP) and cross reconstruction plate (CRP), and to explore the influence of sitting and turning right/left on implants. METHODS PASP, DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum. A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left. RESULTS The peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP > DRP > PASP. The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right; and the minimal was 234.0 Mpa and 0.619 mm when turning left. CONCLUSION PASP can provide higher stability than DRP and CRP for both-column acetabular fractures. The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side, which can avoid implant failure.
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12
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Gökgöz MB, Alemdaroğlu B, Özmeriç A, İltar S, Erbay FK, Demir T. The Effect of Lateralization of a Pelvic Brim Plate on the Fixation of an Anterior Column Fracture: A Biomechanical Analysis. Cureus 2022; 14:e24158. [PMID: 35592198 PMCID: PMC9110042 DOI: 10.7759/cureus.24158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
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13
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Hinz N, Dehoust J, Münch M, Seide K, Barth T, Schulz AP, Frosch KH, Hartel MJ. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg 2022; 48:3541-3560. [PMID: 35305114 PMCID: PMC9532317 DOI: 10.1007/s00068-022-01936-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. Methods A systematic literature research was conducted according to the PRISMA guidelines, using the PubMed/MEDLINE and Web of Science databases. 44 studies conducting biomechanical analyses of fixation of acetabular fractures were identified, which met the predefined inclusion and exclusion criteria and which were published in English between 2000 and April 16, 2021. The studies were analyzed with respect to distinct parameters, including fracture type, material of pelvis model, investigated fixation construct, loading direction, loading protocol, maximum loading force, outcome parameter and measurement method. Results In summary, there was no standardized test setup within the studies on fixation constructs for acetabular fractures. It is therefore difficult to compare the studies directly, as they employ a variety of different test parameters. Furthermore, the clinical implications of the biomechanical studies should be scrutinized, since several test parameters were not based on observations of the human physiology. Conclusion The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01936-9.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Klaus Seide
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Tobias Barth
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Arndt-Peter Schulz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Mönkhofer Weg 239 a, 23562, Lübeck, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany. .,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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14
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Salem M, Westover L, Adeeb S, Duke K. Prediction of fracture initiation and propagation in pelvic bones. Comput Methods Biomech Biomed Engin 2021; 25:808-820. [PMID: 34587835 DOI: 10.1080/10255842.2021.1981883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective is developing an XFEM model that is capable of predicting different types of fracture in the pelvic bone under various loading conditions. Previously published mechanical and failure characteristics of cortical and cancellous tissues were implemented and assigned to an intact pelvic bone with specified cortical and cancellous tissues. Various loading conditions, including combined load directions, were applied to the acetabulum to model different types of fracture (e.g., anterior/posterior wall fracture and transverse fracture) in the pelvic bone. The predicated types of fracture and the maximum force at fracture were compared to those acquired from previously published experimental tests. Anterior/posterior wall fracture and transverse fracture were the most common types of fractures determined in the simulations. The XFEM simulations were able to predict similar fractures to those reported in the experimental tests. The maximum fracture force in the XFEM model was found to be 18.6 kN compared to 8.85 kN reported in the previous experimental tests. The results revealed that different types of fracture in the pelvic bones can be caused by the various loading conditions in unstable high-rate impact loads. Using proper mechanical and failure behaviors of cortical and cancellous tissues, XFEM modeling of pelvic bone is capable of predicting bone fracture. In future work, the XFEM models of cancellous and cortical tissues can be assigned to other bones in human body skeleton so that the failure mechanism in such bones can be investigated.
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Affiliation(s)
- Mohammad Salem
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Kajsa Duke
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
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15
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Deng J, Li M, Li J, Li Z, Meng F, Zhou Y, Tang P, Zhao Y, Zhang L. Finite Element Analysis of a Novel Anatomical Locking Guide Plate for Anterior Column and Posterior Hemi-Transverse Acetabular Fractures. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose
The increasing worldwide prevalence of anterior column-posterior hemi-transverse fracture (ACPHTF) brings formidable challenges to orthopaedic surgeons. Our newly-designed locking plate had previously demonstrated promising effects in ACPHTF, but evidence of their direct comparison with conventional internal fixations remains lacking. In this study, we aimed to compare our novel plate with the traditional devices via finite element analysis.
Methods
The ACPHTF model was created based on a 48-year-old volunteer’s CT data, and then fixed in three different internal fixations: an anterior column locking plate with posterior column screws, double column locking plates, and our novel anatomical locking plate. These models were next loaded with a downward vertical force of 200 N, 400 N and 600 N, and the stress peaks and displacements of three different sites were recorded and analyzed.
Results
We first tested the rigidity and found that our newly-designed locking plate as well as its matched screws had a greater stiffness especially when they were under a higher loading force of 600 N. Then we evaluated the displacements of fracture ends after applying these fixations. Both our novel plate and DLP showed significantly smaller displacement than LPPCS at the anterior column fracture line and the pubic branch fracture line, while our novel plate was not obviously inferior to DLP in terms of the displacement.
Conclusion
This novel plate demonstrates a distinct superiority in the stiffness over LPPCS and DLP and comparable displacements to DLP in ACPHTF, which suggests this novel anatomical locking guide plate should be taken into consideration in ACPHTF.
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16
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Le Quang H, Schmoelz W, Lindtner RA, Dammerer D, Schwendinger P, Krappinger D. Single column plate plus other column lag screw fixation vs. both column plate fixation for anterior column with posterior hemitransverse acetabular fractures - a biomechanical analysis using different loading protocols. Injury 2021; 52:699-704. [PMID: 33454060 DOI: 10.1016/j.injury.2020.12.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Open reduction and internal fixation of both columns is considered the treatment of choice for displaced anterior column with posterior hemitransverse (ACPHT) fractures in non-geriatric patients. Plate fixation of one column combined with lag screw fixation of the other column allows to decrease operative time and approach-related morbidity compared to conventional both column plating. The aim of this biomechanical study was to evaluate whether single column plate plus other column lag screw fixation confers similar stability to both column plate fixation. Physiological loads were simulated using both the single-leg stance (SLS) as well as the sit-to-stand (STS) loading protocols. METHODS A clinically relevant ACPHT fracture model was created using fourth-generation composite hemipelves. Fractures were stabilized with three different fixation constructs: (1) anterior column plate plus posterior column screw fixation (AP+PCS), posterior column plate plus anterior column screw fixation (PP+ACS) and anterior column plate plus posterior column plate fixation (AP+PP). Specimens were loaded from 50 to 750 N with a ramp of 100 N/s. Fracture gap motion (FGM) and relative interfragmentary rotation (RIFR) between the three main fracture fragments were assessed under loads of 750 N using an optical 3D measurement system. RESULTS STS loading generally resulted in higher mean FGM and RIFR than STS loading in the AP+PCS and AP+PP groups, while no significant differences were found in the PP+ACS group. Compared to conventional both column plate fixation (AP+PP), PP+ACS displayed significantly higher FGM and RIFR between the iliac wing and the posterior column during SLS loading. No significant differences in FGM and RIFR were identified between the AP+PCS and the AP+PP group. CONCLUSION Overall, single column plate plus other column lag screw fixation conferred similar stability to conventional both column plate fixation. From a clinical point of view, AP+PCS appears to be the most attractive alternative to conventional AP+PP for internal fixation of ACPHT fractures.
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Affiliation(s)
- Huy Le Quang
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Peter Schwendinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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17
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Xie XJ, Cao SL, Tong K, Zhong ZY, Wang G. Three-dimensional finite element analysis with different internal fixation methods through the anterior approach. World J Clin Cases 2021; 9:1814-1826. [PMID: 33748230 PMCID: PMC7953397 DOI: 10.12998/wjcc.v9.i8.1814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the modernization of society and transportation in the last decades in China, the incidence of high-energy trauma increased sharply in China, including that of acetabular fractures.
AIM To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.
METHODS The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer. After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity, the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones.
RESULTS In the standing position, the maximum stress was 46.21 MPa. In the sitting position, the sacrum bore the simulated gravity load at the upper end. When comparing the five fixations, there were no significant differences in the stress mean values among groups (sitting: P = 0.9794; standing: P = 0.9741). In terms of displacement, the average displacement of the internal iliac plate group was smaller than that of the spring plate group (P = 0.002), and no differences were observed between the other pairs of groups (all P > 0.05). In the standing position, there were no significant differences in the mean value of displacement among the groups (P = 0.2985). It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment.
CONCLUSION There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.
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Affiliation(s)
- Xian-Jin Xie
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Sheng-Lu Cao
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Kai Tong
- Department of Orthopaedic Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430000, Hubei Province, China
| | - Zi-Yi Zhong
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Gang Wang
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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18
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Wu H, Song C, Shang R, Shao Q, Liu X, Zhang H, Cai X. Double column acetabular fractures fixation using a novel dynamic anterior plate-screw system: A biomechanical analysis. Injury 2021; 52:407-413. [PMID: 33097200 DOI: 10.1016/j.injury.2020.10.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND According to the classification of Judet and Letournel, all double column acetabular fractures will certainly involve the disruption of the quadrilateral plate (QLP). Accurate reduction and reliable fixation of QLP is the key to obtain a normal congruent hip joint and avoid postoperative arthritis. The aims of this study were to assess the biomechanical properties of a novel dynamic anterior plate-screw system (named DAPSQ) and to compare its biomechanical stability with buttress-plate construct. METHODS Double column acetabular fractures involving the QLP were created on cadaveric pelvic specimens and subsequently stabilized with (1) a pre-contoured side-specific DAPSQ titanium plate and 4 quadrilateral screws (Group A) or a 12-hole suprapectineal pelvic reconstruction plate combined with a 9-hole 1/3 tube buttress plate (Group B). These constructs were mechanically loaded on ZwickZ 100 testing machine. Construct stiffness and displacement amounts of the two fixation methods in the condition of dynamic axial loading conditions were measured. RESULTS As the axial loading force increased from 200 N to 800 N, the longitudinal displacement of each pelvic specimen increased linearly and Group B was found to have significantly higher displacement than Group A (p<0.05). In the 600 N physiological loading, the construct stiffness values of Groups A and B were 139.4 ± 37.4 N/mm and 101±18.3 N/mm, respectively. Group A is 27% stiffer than Group B(p<0.05). CONCLUSIONS In this in vitro biomechanical study, DAPSQ plate and quadrilateral screws fixation of a double column acetabular fracture involving the QLP resulted in a better fixation construct than the traditional suprapectineal pelvic reconstruction plate and 1/3 tube buttress plate fixation.
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Affiliation(s)
- Haiyang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, 430070,China
| | | | - Ranran Shang
- Department of Orthopaedic surgery, Wuhan NO.1 Hospital, Hubei University of Chinese Medicine, Wuhan, 430022, China
| | - Qipeng Shao
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, 430070,China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, 430070,China
| | - Hongqi Zhang
- Wuhan University of Technology, Department of Mechanical Room, Wuhan, 430070, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, 430070,China.
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19
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Wu H, Shao Q, Shang R, Song C, Liu X, Cai X. Open reduction and internal fixation of quadrilateral plate fractures in the elderly: association between initial fracture pattern and outcomes. BMC Musculoskelet Disord 2021; 22:122. [PMID: 33514361 PMCID: PMC7846999 DOI: 10.1186/s12891-021-04002-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background Acetabular fractures with medial displacement of the quadrilateral plate (QLP) are common in the elderly. The presence of QLP fractures greatly increase the surgical difficulty of acetabular fractures. This study aims to evaluate the clinical radiological outcomes of open reduction and internal fixation (ORIF) in QLP fractures in elderly patients and to investigate factors potentially affecting the result. Methods We conducted a retrospective study. A series of 37 consecutive patients with acetabular fracture involving the QLP aged 60 years and older who received ORIF between January 2010 and May 2019 were included. QLP fractures were classified according to Walid’s classification system. Radiological outcomes were evaluated using Matta criteria and functional outcomes were assessed using the modified Merle d’Aubigné score. The relationships between Walid’s classification and radiological or functional outcomes were analyzed. Results According to Walid’s classification, 18, 13, 6 were classified as QLP1, QLP2 and QLP3, respectively. The average follow-up was 35.5 ± 10.7 months. We obtained anatomic reduction in 48.6 % (18/37) of cases, imperfect reduction in 40.5 % (15/37) of cases, and poor reduction in 10.8 % (4/37) of cases. Excellent-good functional scores were found in 83.7 % (modified Merle d’Aubigné). There were no cases of screw entering the hip, pull-out and loosening or implant failure during the follow-up. Walid’s classification was positively correlated with radiological outcomes of reduction (r = 0.661; P < 0.001), and functional outcomes (r = 0.478; P = 0.003). Unsatisfactory reduction was demonstrated a correlation with the development of post-traumatic arthritis (r =-0.410; P = 0.012). Conclusions ORIF may be suggested for quadrilateral plate fractures in the elderly. Walid’s classification system is associated with the reduction quality and functional recovery.
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Affiliation(s)
- Haiyang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, 430070, Wuhan, China
| | - Qipeng Shao
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, 430070, Wuhan, China
| | - Ranran Shang
- Department of Orthopaedic Surgery, First Hospital of Wuhan, Hubei University of Chinese Medicine, 430022, Wuhan, China
| | - Chengjing Song
- Chengjing Song Huaiyin hospital of huai an city, 223300, Huaian, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, 430070, Wuhan, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, 430070, Wuhan, China.
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20
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Li Y, Feng R, Liu X, Wang G, Wang W, Lu Q, Huang W, Wu H, Cai X. A Post-Traumatic Osteoarthritic Model of Hip Following Fracture of Acetabulum in Rabbit: A Preliminary Study by Macroscopic and Radiographic Assessment. Orthop Surg 2021; 13:296-305. [PMID: 33398932 PMCID: PMC7862151 DOI: 10.1111/os.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023] Open
Abstract
Objective To develop a post‐traumatic osteoarthritic model of hip following fracture of acetabulum in rabbit for revealing biochemical mechanism of post‐traumatic osteoarthritis. Methods A total of 36 mature male New Zealand white rabbits were equally divided into sham group (n = 12), non‐ORIF group (n = 12), and open reduction and internal fixation (ORIF) group (n = 12). Except for the sham group, rabbits had survival surgeries to create acetabular fractures of dorsal wall for simulating dashboard impaction mechanism. The ORIF group received open reduction and internal fixation, while fractures in the non‐ORIF group were left as displaced but transverse fracture and dislocation was reduced. Besides intraoperative appearance and postoperative recovery, macroscopic and radiographic characteristics of the hips were recorded and assessed by a radiographic scoring scale at 3 weeks, 6 weeks, and 6 months, respectively. Results Out of 24 modeled acetabula, 21 (87.5%) were pure dorsal wall fractures as proposed and the remaining three were associated fractures (dorsal wall plus transverse fracture) accompanied by dorsal dislocation or not. All hips were stable, and no sciatic nerve injury was observed. One rabbit in the ORIF group died of deep infection 4 days after surgery. Rabbits in the sham and ORIF groups returned to normal gait in 2 weeks, but animals in the non‐ORIF group suffered from limping and restricted movement. As the time progressed, the hips in the non‐ORIF group experienced progressive and severe degeneration which exhibited dramatically malformed and hypertrophic joints at 6 months, but the ORIF group maintained much better morphological structure. Corresponding to morphological changes, the average radiographic scores of the non‐ORIF group increased from 1.25 at 3 weeks to 2.75 at 6 months and showed statistically significant difference when compared to the sham group at all three time points (P = 0.011, 0.011, 0.015, respectively, <0.0167). Although the scores of the ORIF group showed apparent improvements (increased from 0.67 at 3 weeks to 2.00 at 6 months), there was no significant difference between the two modeled groups at all three time points. Conclusion The fracture model with high consistency and reproducibility showed progressive post‐traumatic osteoarthritic changes which could be improved by open reduction and internal fixation surgery and provided an alternative selection for investigating potential pathogenesis and pathology of post‐traumatic osteoarthritis following fracture of acetabulum.
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Affiliation(s)
- Yanjin Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Orthopedics, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Ruibing Feng
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Guodong Wang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Wei Wang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Orthopedics, Hubei Province hospital of Traditional Chinese Medicine, Wuhan, China
| | - Qilin Lu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Spine Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, China
| | - Wei Huang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Spine Surgery, Jingmen NO.2 People's Hospital, Jingmen, China
| | - Haiyang Wu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xianhua Cai
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
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21
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Le Quang H, Schmoelz W, Lindtner RA, Schwendinger P, Blauth M, Krappinger D. Biomechanical comparison of fixation techniques for transverse acetabular fractures - Single-leg stance vs. sit-to-stand loading. Injury 2020; 51:2158-2164. [PMID: 32646647 DOI: 10.1016/j.injury.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To biomechanically compare five different fixation techniques for transverse acetabular fractures using both the single-leg stance (SLS) and the sit-to-stand (STS) loading protocols and to directly compare fracture gap motion (FGM) and relative interfragmentary rotation (RIFR). METHODS Transtectal transverse acetabular fractures were created on fourth-generation composite hemipelves in a reproducible manner. Five different fixation techniques were biomechanically assessed using both an SLS and STS loading protocol: anterior plate (AP) only, posterior plate (PP) only, anterior plate plus posterior column screw (AP+PCS), posterior plate plus anterior column screw (PP+ACS) and anterior plus posterior plate (AP+PP). After preconditioning, the specimens were loaded from 50 to 750 N with a ramp of 100 N/s. FGM and RIFR under loads of 750 N were measured using an optical 3D measurement system. RESULTS In the three groups of fixation techniques addressing both columns, STS loading resulted in higher mean FGM and in RIFR than SLS loading. No construct failure was observed. In the single plate groups (AP only and PP only), STS loading resulted in failure of all specimens before reaching loads of 750 N, while no failure occurred after SLS loading. No significant differences in FGM and RIFR were found between the double plate (AP+PP) and the single plate plus column screw (AP+PCS and PP+ACS) techniques. CONCLUSION SLS loading appeared to overestimate the strength of acetabular fracture fixation constructs and STS loading may be more appropriate to provide clinically relevant biomechanical data. Internal fixation of a single column might not provide adequate stability for transverse fractures, while strength of single plate plus column screw fixation and double plate fixation was comparable.
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Affiliation(s)
- Huy Le Quang
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Peter Schwendinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Michael Blauth
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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22
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Wu HY, Shao QP, Song CJ, Shang RR, Liu XM, Cai XH. Personalized Three-Dimensional Printed Anterior Titanium Plate to Treat Double-Column Acetabular Fractures: A Retrospective Case-Control Study. Orthop Surg 2020; 12:1212-1222. [PMID: 32725701 PMCID: PMC7454211 DOI: 10.1111/os.12741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
Objective To compare the clinical efficacy and safety of a personalized three‐dimensional (3D) printed dynamic anterior plate–screw system for the quadrilateral area (DAPSQ) titanium plate and a traditional DAPSQ reconstruction plate in the treatment of double‐column acetabular fractures. Methods This was a retrospective case‐control study. From May 2014 to January 2018, 43 patients with double‐column acetabular fractures underwent open reduction and internal fixation. Among these, 20 cases were fixed with a 3D printed DAPSQ plate (3D printed group) and 23 cases were fixed with a DAPSQ reconstruction plate (control group). The 3D printed group comprised 15 men and 5 women, with an average age of 50.1 ± 8.2 years. The control group comprised 16 men and 7 women, with an average age of 51.0 ± 8.6 years. The evaluation index included the surgical data (i.e. blood loss, operating time, duration of hospital stay, and intraoperative and postoperative complications), position and length of implants, reduction quality, hip function, and related complications. The reduction quality was evaluated using the Matta scoring standard and hip function was evaluated using the modified Merle d’Aubigné score. Results A total of 43 patients met the inclusion criteria. The mean postoperative follow up was 35.2 months in the 3D printed group and 36.9 months in the control group. There were no significant group differences in demographic data between the two groups. The position and length of the 3D printed implants were generally in accord with preoperative planning using a 3D pelvic model. Patients in the 3D printed group had significantly shorter operation time (223.2 vs 260.5 min, P < 0.05) and less intraoperative blood loss (930.4 vs 1426.1 mL, P < 0.05) compared to the control group. Anatomic, imperfect, and poor reduction was obtained in 13, 5, and 2 cases in the 3D printed group, respectively, and was obtained in 12, 8, and 3 cases in the control group. The modified Merle d’Aubigné scores were excellent in 11 cases, good in seven cases, and fair in two cases in the 3D printed group. They were excellent in 11 cases, good in eight cases, fair in three cases, and poor in one case in the control group. The reduction quality and hip function did not differ within the groups (P > 0.05). The general complication rate in the 3D printed group and the control group was 15% and 26.1%, respectively, but the difference between the two groups was not statistically significant. Conclusion Use of a personalized 3D printed DAPSQ plate has potential advantages in reducing the operation time and blood loss during the treatment of double‐column acetabular fractures.
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Affiliation(s)
- Hai-Yang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Qi-Peng Shao
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Cheng-Jing Song
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Ran-Ran Shang
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Xi-Ming Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Xian-Hua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
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23
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Liu L, Fan S, Chen Y, Peng Y, Wen X, Zeng D, Song H, Jin D. Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures. Med Sci Monit 2020; 26:e915886. [PMID: 32163378 PMCID: PMC7092661 DOI: 10.12659/msm.915886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Despite the development of minimally invasive techniques for pelvic fractures, performing minimally invasive surgery for Tile C3 pelvic fractures remains challenging. Thus, we propose use of anterior ring internal fixation combined with sacroiliac screw fixation for Tile C3 pelvic fractures. Material/Methods A normal pelvic finite element model (model 1) was established. Two-screw, three-screw, and four-screw anterior ring internal fixators and plate combined with sacroiliac screw Tile C3 pelvic fracture models (models 2, 3, 4, and 5, respectively) were also established. A vertical load of 600 N was applied on S1. The distribution of displacement and stress in the standing and sitting positions was compared. Results Models 2, 3, 4, and 5 can provide effective fixation. Compared with model 1, in the erect position, the maximum displacement of models 2, 3, 4, and 5 increased by 66.51%, 65.36%, 35.16%, and 35.47% and the maximum stress increased by 201.78%, 130.65%, 100.82%, and 99.03%, respectively. Compared with model 1, in sitting position, the maximum displacement of models 2, 3, 4, and 5 increased by 9.1%, 11.04%, 5.57%, and 8.59% and the maximum stress increased by 157.73%, 118.02%, 98.32%, and 93.16%, respectively. Conclusions Anterior ring internal fixators combined with sacroiliac screws can effectively fix Tile C3 pelvic fractures.
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Affiliation(s)
- Lin Liu
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland).,Department of Traumatic Orthopaedics, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Shicai Fan
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Yuhui Chen
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Yongxing Peng
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Xiangyuan Wen
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Donggui Zeng
- Department of Traumatic Orthopaedics, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Hui Song
- Department of Traumatic Orthopaedics, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Dadi Jin
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
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Biomechanical Evaluation of a New Fixation Type in 3D-Printed Periacetabular Implants using a Finite Element Simulation. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9050820] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pelvic implants require complex geometrical shapes to reconstruct unusual areas of bone defects, as well as a high mechanical strength in order to endure high compressive loads. The electron beam melting (EBM) method is capable of directly fabricating complex metallic structures and shapes based on digital models. Fixation design is important during the 3D printing of pelvic implants, given that the fixation secures the pelvic implants to the remaining bones, while also bearing large amounts of the loads placed on the bone. In this study, a horseshoe-shaped plate fixation with a bridge component between two straight plates is designed to enhance the mechanical stability of pelvic implants. The aim of this study is to investigate the biomechanics of the horseshoe-shaped plate fixation in a 3D-printed pelvic implant using a finite element (FE) simulation. First, computed tomography (CT) scans were acquired from a patient with periacetabular bone tumors. Second, 3D FE implant models were created using the patient’s Digital Imaging and Communications in Medicine (DICOM) data. Third, a FE simulation was conducted and the stress distribution between a conventional straight-type plate model, and the horseshoe-shaped plate model was compared. In both of the models, high-stress regions were observed at the iliac fixation area. In contrast, minimal stress regions were located at the pubic ramus and ischium fixation area. The key finding of this study was that the maximal stress of the horseshoe-shaped plate model (38.6 MPa) was 21% lower than that of the straight-type plate model (48.9 MPa) in the iliac fixation area. The clinical potential for the application of the horseshoe-shaped plate fixation model to the pelvic implant has been demonstrated, although this is a pilot study.
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25
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Becker CA, Kammerlander C, Cavalcanti Kußmaul A, Dotzauer F, Woiczinski M, Rubenbauer B, Sommer F, Linhart C, Weidert S, Zeckey C, Greiner A. Minimally invasive screw fixation is as stable as anterior plating in acetabular T-Type fractures - a biomechanical study. Orthop Traumatol Surg Res 2018; 104:1055-1061. [PMID: 30179721 DOI: 10.1016/j.otsr.2018.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Operative treatments of T-type acetabular fractures are challenging surgical procedures. Open reduction and internal fixation is the standard method for the operative management of these fractures, however this is associated with high blood loss, long hospital stay and longer rehabilitation. Anterior subcutaneous pelvic fixation (internal fixation=INFIX) and retrograde pubic screw fixation have shown promising results in minimally invasive treatment of pelvic ring fractures. For T-type acetabular fractures, however, minimally invasive treatment concepts are still rare. Therefore we performed a mechanical in vitro study to: - investigate the potential favorability of minimally invasive treatment options over the already established open anterior locking plate osteosynthesis of acetabular T-fractures regarding biomechanical stability and post-surgical stiffness; - explore the biomechanical feasibility of the INFIX; - assess its potential ability to reduce the anterior acetabular column. HYPOTHESIS A minimally invasive treatment of acetabular T-type fractures is biomechanically equivalent to an open anterior plate osteosynthesis. METHODS Twenty-four synthetic hemipelvis specimens with a T-type acetabular fracture were divided in four groups. A posterior column screw was placed in every pelvis of every group. The anterior column was fixed with: - anterior column screw; - anterior column screw incl. INFIX; - INFIX alone; - 14-hole angular stable locking plate (standard fixation method). Displacement of the anterior column was reduced in group 2+3 using the INFIX. All specimens were cyclically loaded with 200N until a maximum of 600N. Movement/displacement of the fracture fragments were detected with a 3D-ultrasound measuring system. Displacement (mm) and Stiffness (N/mm) of the construction were analyzed. RESULTS Statistical assessment showed no significant differences between the four fixation types (p>0.05). The 14-whole locking plate (group 4) displayed the overall highest stability with a displacement of 1.3±0.04mm and stiffness of 76.3±2.4N/mm. Anterior screw fixation (group 1) proved to be the minimally invasive fixation method with the least displacement and highest stiffness (1.5±0.2mm, 68.3±6.8N/mm). The combination of an INFIX and an anterior column screw (group 2), showed a mean stiffness of 62.1±6.0N/mm and a mean displacement of 1.7±0.2mm. INFIX only (group 3) presented a displacement of 1.6±0.1mm and a stiffness of 64.5±4.5N/mm. DISCUSSION Minimally invasive fixation techniques for T-type acetabular fractures show promising biomechanical stability in non- or slightly displaced fractures. Furthermore, INFIX could be a feasible tool for the reduction of the anterior acetabular column. LEVEL OF EVIDENCE III, case control prospective experimental study.
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Affiliation(s)
- Christopher A Becker
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Christian Kammerlander
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Fabian Dotzauer
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany; Department of trauma surgery, hospital of Schongau, Marie-Eberth-Straße 6, 86956 Schongau, Germany
| | - Matthias Woiczinski
- Department of Orthopedics, physical medicine and rehabilitation, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Bianka Rubenbauer
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Fabian Sommer
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Christoph Linhart
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Simon Weidert
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Christian Zeckey
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany.
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26
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Tanoğlu O, Alemdaroğlu KB, İltar S, Özmeriç A, Demir T, Erbay FK. Biomechanical comparison of three different fixation techniques for anterior column posterior hemitransverse acetabular fractures using anterior intrapelvic approach. Injury 2018; 49:1513-1519. [PMID: 29934096 DOI: 10.1016/j.injury.2018.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/01/2018] [Accepted: 06/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to biomechanically compare three different fixation methods for the fixation of anterior column posterior hemitransverse type acetabular fracture (ACPHT). METHODS ACPHT fracture models were created on twenty-four foam cortical shell artificial hemipelvis models. Three fixation methods were assessed - Group 1: posterior column lag screws over a suprapectineal plate; Group 2: Posterior column lag screws over a suprapectineal plate and an infrapectineal plate; Group 3: A suprapectineal plate and a vertical infrapectineal plate. Stiffness and displacement amounts of fixation methods under dynamic and static axial loading conditions were measured. RESULTS In the dynamic and static tests, Group 3 showed the less stable fixation compared to Group 2. There was no statistically significant difference between the stiffness values of the fixation groups. In the static tests, there was no statistically significant difference between Group 1 and 2, although less displacements were obtained in Group 2. CONCLUSIONS A combination of posterior lag screws over a suprapectineal plate and an infrapectineal plate supporting the pelvic brim along both sides of the linea terminalis resulted in a better fixation construct than a suprapectineal plate accompanying with a vertical infrapectineal plate provide better stability with less fracture displacement.
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Affiliation(s)
- Oğuzhan Tanoğlu
- Erzincan University Mengücek Gazi Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
| | | | - Serkan İltar
- SBU Ankara Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Ahmet Özmeriç
- SBU Ankara Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Teyfik Demir
- TOBB Economics and Technology University, Mechanical Engineering Department, Turkey
| | - Fatma Kübra Erbay
- TOBB Economics and Technology University, Micro-Nanotechnology Programme, Turkey
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