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Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.

ABSTRACT: OBJECTIVE:The purpose of this study was to compare the stability and feasibility of four fixation constructs in a posterior column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate. METHODS:Twenty embalmed cadaveric pelvises with a posterior column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a posterior column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force. RESULTS:Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p<0.05), a single reconstruction plate with lag screw (p<0.05), and two reconstruction plates (p<0.05). CONCLUSIONS:The novel W-shaped acetabular angular plate fixation technique was able to provide the biomechanically stiffest construct for stabilization of a posterior column acetabular fracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.

SUBMITTER: Su K

PROVIDER: S-EPMC5695793 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.

Su Ke K Liu Song S Wu Tao T Yin Yingchao Y Zhang Ruipeng R Li Shilun S Zhang Yingze Y

PloS one 20171120 11

<h4>Objective</h4>The purpose of this study was to compare the stability and feasibility of four fixation constructs in a posterior column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate.<h4>Methods</h4>Twenty embalmed cadaveric pelvises with a posterior column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a posterior col ...[more]

PMID: 29155842

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Project description:BACKGROUND:Geriatric acetabular fractures require fixation with sufficient primary stability to allow for immediate full-weight bearing. Minimally-invasive procedures would be desirable in order to keep perioperative morbidity low. The purpose of this study was to compare the biomechanical strength of lag screw-only fixation of anterior column posterior hemi-transverse (ACPHT) acetabular fractures to standard anatomical plate fixation. METHODS:Standardized ACPHT fractures were created in fourth generation synthetic pelvis models and stabilized by either an anatomical buttress plate (n?=?4) or by a screw-only construct (n?=?4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (3200?cycles, 175?N to 2250?N). Construct survival, acetabular fracture motion, and mode of failure were assessed. RESULTS:The median number of cycles needed until failure of the construct occurred was 2304?cycles (range, 2020 to 2675) in the plate fixation group and 3200?cycles (range, 3101 to 3200) for the screw fixation constructs (p?=?.003). With regard to energy absorbed until failure, the plate fixation group resisted to 1.57?×?106?N*cycles (range, 1.21?×?106 to 2.14?×?106) and the screw fixation group to 3.17?×?106?N*cycles (range, 2.92?×?106 to 3.17?×?106; p?=?.001). All plate fixation specimens failed with a break-out of the posterior-column screw in the quadrilateral wing of the anatomical plate within a maximum load of 1750?N while the screw fixation constructs all survived loading of at least 2100?N. Acetabular fracture gap motion, acetabular rim angle, and medial femoral head subluxation as measures of fracture displacement were all not different between the two groups (p?>?0.1). CONCLUSIONS:In this in vitro biomechanical study, screw-only fixation of an ACPHT acetabular fracture resulted in at least as good construct survival as seen for standard buttress plate fixation. Both methods resisted sufficiently to forces that would be expected under physiologic conditions.

Dataset Information

Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.

Publications

Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.

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