Biomechanical Comparison of Sacroiliac Screw Techniques for Unstable Pelvic Ring Fractures

Objective: To determine the stiffness and strength of various sacroiliac screw fixations to compare different sacroiliac screw techniques. Design: Randomized comparative study on embalmed human pelvises. Materials and Methods: In 12 specimens, we created a symphysiolysis and sacral fractures on both sides. Each of these 24 sacral fractures was fixed with 1 of the following methods: 1 sacroiliac screw in the vertebral body of S1, 2 screws convergingly in S1, or 1 screw in S1 and 1 in S2. On the left and right side of a pelvis, different techniques were used. The pubic symphysis was not stabilized. We measured the translation and rotation stiffness of the fixations and the load to failure using a 3-dimensional video system. Results: The stiffness of the intact posterior pelvic ring was superior to any screw technique. Significant differences were found for the load to failure and rotation stiffness between the techniques with 2 screws and a single screw in S1. The techniques utilizing 2 screws showed no differences. Conclusions: Based on the results of this study, we can conclude that a second sacroiliac screw in completely unstable pelvic fractures increases rotation stiffness and improves the load to failure.

[1]  M Tile,et al.  Pelvic ring fractures: should they be fixed? , 1988, The Journal of bone and joint surgery. British volume.

[2]  N. Sharkey,et al.  Biomechanical testing of new and old fixation devices for vertical shear fractures of the pelvis. , 1991, Journal of orthopaedic trauma.

[3]  C. J. Keemink,et al.  Upgrading of efficiency in the tracking of body markers with video techniques , 2006, Medical and Biological Engineering and Computing.

[4]  A. Peitzman,et al.  Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. , 1995, The Journal of trauma.

[5]  Michael E. Miller,et al.  Posterior Pelvic Fixation Using a Transiliac 4.5-mm Reconstruction Plate: A Clinical and Biomechanical Study , 1993, Journal of orthopaedic trauma.

[6]  P. Duwelius,et al.  Computed Tomography‐Guided Fixation of Unstable Posterior Pelvic Ring Disruptions , 1992, Journal of orthopaedic trauma.

[7]  Richard M. Harrington,et al.  Internal Fixation for the Transforaminal Sacral Fracture , 1996, Clinical orthopaedics and related research.

[8]  T. Hearn,et al.  Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. , 1995, Injury.

[9]  H. Tscherne,et al.  [Comparative biomechanical studies of internal stabilization of trans-foraminal sacrum fractures]. , 1992, Der Orthopade.

[10]  P. Duwelius,et al.  CT-guided fixation of sacral fractures and sacroiliac joint disruptions. , 1991, Radiology.

[11]  A. Tencer,et al.  Internal Fixation of the Unstable Anterior Pelvic Ring: A Biomechanical Comparison of Standard Plating Techniques and the Retrograde Medullary Superior Pubic Ramus Screw , 1994, Journal of orthopaedic trauma.

[12]  P. Simonian,et al.  Closed reduction and percutaneous skeletal fixation of sacral fractures. , 1996, Clinical orthopaedics and related research.

[13]  C. Snijders,et al.  Mobility of the First Tarsometatarsal Joint in Relation to Hallux Valgus Deformity: Anatomical and Biomechanical Aspects , 1999, Foot & ankle international.

[14]  N. Ebraheim,et al.  Percutaneous Computed Tomography‐Guided Stabilization of Posterior Pelvic Fractures , 1994, Clinical orthopaedics and related research.

[15]  A. V. van Vugt,et al.  Fluoroscopic positioning of sacroiliac screws in 88 patients. , 2002, The Journal of trauma.

[16]  D. C. Mears,et al.  Comparative mechanical performances of some new devices for fixation of unstable pelvic ring fractures , 1983, Medical and Biological Engineering and Computing.

[17]  S. Goodman,et al.  Stability of open-book pelvic fractures using a new biomechanical model of single-limb stance. , 1997, Journal of orthopaedic trauma.

[18]  J. Keating,et al.  Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. , 1999, Journal of orthopaedic trauma.

[19]  E Schneider,et al.  Fixation of Transforaminal Sacrum Fractures: A Biomechanical Study , 1993, Journal of orthopaedic trauma.

[20]  W. Mills,et al.  Iliosacral screw fixation: early complications of the percutaneous technique. , 1997, Journal of orthopaedic trauma.

[21]  J. Thomine,et al.  Experimental Study of the Sacroiliac Joint Micromotion in Pelvic Disruption , 2002, Journal of orthopaedic trauma.

[22]  Richard M. Harrington,et al.  Biomechanical Simulation of the Anteroposterior Compression Injury of the Pelvis: An Understanding of Instability and Fixation , 1994, Clinical orthopaedics and related research.

[23]  B. McGrory,et al.  Fractures of the Pelvis and Acetabulum , 2003 .

[24]  C. Sar,et al.  S1 Pediculoiliac Screw Fixation in Instabilities of the Sacroiliac Complex: Biomechanical Study and Report of Two Cases , 2003, Journal of orthopaedic trauma.

[25]  P. Kregor,et al.  Percutaneous iliosacral screws with the patient supine technique , 1993 .

[26]  D. Wetterkamp,et al.  Clinical and biomechanical aspects of external fixation of the pelvis. , 1996, Clinical biomechanics.

[27]  H. Tullos,et al.  Anterior and posterior internal fixation of vertical shear fractures of the pelvis , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[28]  C. Spoor,et al.  Rigid body motion calculated from spatial co-ordinates of markers. , 1980, Journal of biomechanics.

[29]  J. Shaw,et al.  Posterior stabilization of pelvic fractures by use of threaded compression rods. Case reports and mechanical testing. , 1985, Clinical orthopaedics and related research.

[30]  J. Matta,et al.  Internal fixation of pelvic ring fractures. , 1989, Clinical orthopaedics and related research.

[31]  S. Goodman,et al.  Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. , 1996, Journal of orthopaedic trauma.

[32]  M. Davidson,et al.  Internal fixation of displaced fractures of the sacrum. , 1996, Clinical orthopaedics and related research.

[33]  H. M. Karara,et al.  Direct Linear Transformation from Comparator Coordinates into Object Space Coordinates in Close-Range Photogrammetry , 2015 .