The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared with External Fixation

• Published in: Journal of bone and joint surgery. American volume 2019-10, Vol.101 (19), p.1724-1731
• Main Authors: Jordan, Martin C., Brems, Anna-Christina, Heintel, Timo, Jansen, Hendrik, Hoelscher-Doht, Stefanie, Meffert, Rainer H.
• Format: Article
• Language: English
• Subjects: Biomechanical Phenomena; Bone Screws; Equipment Design; External Fixators - standards; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - standards; Fractures, Bone - surgery; Humans; Internal Fixators - standards; Models, Anatomic; Pelvic Bones - injuries; Pelvic Bones - surgery; Random Allocation; Surgical Instruments
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.18.01363

Subcutaneous fixation of the anterior pelvic ring is an emerging surgical technique for trauma patients. The aim of this study was to biomechanically evaluate 2 internal fixation devices for stabilizing a disrupted pelvic ring and compare them with traditional external fixation. Thirty-six synthetic pelvises with a simulated unstable ring fracture (anteroposterior compression type III) were divided into 3 groups. Group A underwent fixation with a supra-acetabular external fixator; group B, with an internal fixator using the USS II polyaxial system; and group C, with an internal fixator using the Click'X polyaxial system. Biomechanical testing included measurement of peak-to-peak displacement at 300, 400, and 500 N; total displacement; plastic deformation; stiffness; and fracture-line displacement. Statistical analysis of all measured parameters revealed no significant differences among the groups. However, vertical displacement of the preshaped connecting rod within the screw heads occurred as a result of inadequate stability of the internal fixation at the rod-screw interface. Although internal fixator devices are placed close to the bone and should therefore maintain greater stiffness, our data did not support the hypothesis of superior stability. Special attention is required when using a curved connecting rod as the rod is easily displaced, placing relevant anatomical structures at risk. These devices require further refinement to avoid potential patient injury.