Fixation Comparison Technique the Pubic Ramus Screw Fixation and Titanium Elastic Nail Versus Standard Plating in Cadaveric Study
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Abstract
Objective : To study biomechanic effect of pubic ramus fracture fixation.the biomechanical evalution compared standard plating technique, retrograde intramedullary screw and titanium elastic nail osteosysthesis in human cadaveric by considering mechanical axial load to failure.
Material and methods : Eighteen each hemi-pelvis specimens dissect for study. 3 Group of material
fixation. Mean age of 70 yrs were harvested. An APC-II unstable pelvic injury hemi pelvis. Group A Hemi-pelvis fixation anterior 10 hole 3.5 mm reconstruction plate with four 3.5 mm cortical screws. Group B. disruption as APC-II but fixation with 6.5 mm retrograde medullary screw 90 mm long. Group C. disruption APC-II but fix with 4mm diameter titanium elastic nail. The specimens originated without skeletal disease. Fixation platform test setup for biomechanic testing with anterior and posterior marker attached for optical vertical loading direction through the acetabulum.
Results : General information of cadaveric from each group result showed plate fixation decrease pubic ramus slightly better than retrograde intramedullary fixation but significant if compare with titanium elastic nail.(P <0.05) When compare disruption between retrograde medullary screws and titanium elastic nail.
Axial load compression to failure (newton) of different type fixation anteroposterior compression type II hemi-pelvis. Disrupted pelvis fixed with 4.0 mm diameter titanium elastic nail, Disrupted pelvis fixed with 6.5 mm diameter retrograde intramedullary screws 90 mm long, Disrupted pelvis fixed with contoured 3.5 mm 10 hole low profile reconstruction plate to superior pubic rami. Statistical significance P < 0.05 standard plating strongest resisted cyclic load. Failure mode in group A plating the specimen exclusively failed by plate bending, group B,C failure mode was characterized by screw cutting through the cancellous or blend intramedullary .
Conclusion : This study show the stabilization for pubic ramus fracture with standard plating (3.5 mm contour low profile reconstruction plate) was still strongest of choice fixation in biomechanic testing for pelvic injury type anteroposterior pubic rami fracture .Provide anterior pelvic stability superior comparable to other fixation type While alternative fixation such as retrograde intramedullary screw, Titanium elastic nail could be placed intramedullary for fixation after reduction. But still not having enough strength for resisted cyclic load or torsion. However, the extensive soft tissue dissection required for plating must be considered in contrast to the minimally invasive intramedullary fixation.
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บทความที่ได้รับการตีพิมพฺเป็นลิขสิทธิ์ของวารสาร
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