Advertisement
Paper| Volume 28, ISSUE 7, P469-475, September 1997

The unstable iliac fracture: a biomechanical evaluation of internal fixation

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Neither plating nor lag screw fixation of a displaced iliac wing fracture as part of an unstable pelvic ring disruption has been studied biomechanically. The purpose of this study was to compare the stability of various combinations of fixation, specifically contrasting lag screws placed between the tables of the ilium with plating in different locations across the fracture line. Various combinations of these fixation implants were evaluated for an unstable iliac fracture. A longitudinal iliac fracture was created in each of six hemi-pelvic specimens prior to testing. Compressive force, up to 500 N or to the magnitude necessary to displace the fracture 2mm, was applied to the fracture line through the hemi-pelvis for each of the plate and lag screw combinations tested. There was no statistical difference between any of the implants or combinations tested. A single 3.5-mm reconstruction (cephalad) plate placed along the cephalad internal aspect of the iliac crest provided the least stability allowing 2 mm of displacement with a mean load of 80N. The two combinations of fixation that required the greatest loads for 2 mm of displacement were a single 3.5-mm lag (cephalad) screw inserted into the iliac crest between the tables of the ilium coupled with either a 3.5-mm reconstruction (brim) plate placed along the internal aspect of the inferior iliac fossa at the pelvic brim (239 N) or a 4.5-mm lag (brim) screw between the inner and outer tables at the inferior aspect of the fracture just above the greater sciatic nothch (225 N).
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Burgess A.
        • Eastridge B.
        • Young J.
        Pelvic ring disruptions: effective classification system and treatment protocols.
        J Trauma. 1990; 30: 848-856
        • Tile M.
        • Pennal G.
        Pelvic disruptions: principles of management.
        Clin Orthop. 1980; 151: 56-64
        • Lange R.
        • Hansen S.
        Pelvic ring disruptions with symphysis pubis diastasis: indications, technique, and limitations of anterior internal fixation.
        Clin Orthop. 1985; 201: 130-137
        • Matta J.
        • Saucedo T.
        Internal fixation of pelvic ring fractures.
        Clin Orthop. 1989; 242: 83-87
        • Mears D.
        • Rubash H
        External and internal fixation of the pelvic ring.
        AAOS Instructional Course Lectures. 1984; 37: 144-158
        • Peltier L.
        Fractures of the pelvis. A report of eighty cases treated at university hospitals.
        Minn Med. 1995; 38: 563-564
        • Simonian P.
        • Routt M.
        • Harrington R.
        • Tencer A.
        Biomechanical comparison of different forms of posterior internal fixation for the unstable transforaminal sacral fracture.
        Trans Orthopaedic Research Society. 1995; 41: 575
        • Simonian P.
        • Routt M.
        • Harrington R.
        • Tencer A.
        Box plate fixation of the disrupted pelvic ring: biomechanical evaluation of a new technique.
        J Orthop Trauma. 1994; 8: 483-489
        • Simonian P.
        • Routt M.
        • Harrington R.
        • Tencer A.
        Internal fixation of the unstable anterior pelvic ring: a biomechanical comparison of standard plating techniques and the retrograde medullary superior public ramus screw.
        J Orthop Trauma. 1994; 8: 476-482
        • Simonian P.T.
        • Routt M.L.R.
        • Harrington R.M.
        • Mayo K.A.
        • Tencer A.F.
        Biomechanical simulation of the anteroposterior compression injury of the pelvis: an understanding of instability and fixation.
        Clin Orthop Rel. Res. 1994; 309: 245-256
        • Tile M.
        Pelvic fractures: operative versus nonoperative treatment.
        Orthop Clin North America. 1980; 11: 423-464
        • Malgaigne J.
        Traite des fractures et des luxations.
        J. B. Lippincott Co, Paris, Philadelphia1859
        • Ben-Menachem Y.
        • Coldwell D.
        • Young J.
        • Burgess A.
        Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management.
        AJR Am J Roentgenol. 1991; 157: 1005-1014
        • Brown J.
        • Greene F.
        • McMillin R.
        Vascular injuries associated with pelvic fractures.
        Am Surg. 1984; 50: 150-154
        • Kahn B.
        Superior gluteal artery laceration: a complication of iliac bone graft surgery.
        Clin Orthop. 1979; 140: 204-207
        • Rothenberger D.
        • Fischer R.
        • Perry Jr., J.
        Major vascular injuries secondary to pelvic fractures: an unsolved clinical problem.
        Am J Surg. 1978; 136: 660-662
        • Smith K.
        • Ben-Menachem Y.
        • Duke J.J.
        • GL H.
        The superior gluteal: an artery at risk in blunt pelvic trauma.
        J Trauma. 1976; 16: 273-279
        • Sundaram M.
        • Patel B.
        • Woverson M.
        Superior gluteal artery hemorrhage following pelvic fractures controlled by embolisation.
        Clin Radiol. 1981; 32: 187-190
        • Brown T.D.
        • Sigal L.
        • Njus G.O.
        • Njus N.M.
        • Singerman R.J.
        • Brand R.A.
        Dynamic performance of the liquid metal strain gauge.
        J Biomech. 1986; 19: 165-173
        • Stocks G.
        • Gabel G.
        • Nobel P.
        Anterior and posterior internal fixation of vertical shear fractures of the pelvis.
        J Orthop Res. 1991; 9: 237-245
        • Charnley G.
        • Dorrell J.
        Small bowel entrapment in an iliac wing fracture.
        Injury. 1993; 24: 627-628