3-dimensional movement analysis after internal fixation of pelvic ring fractures. A computer simulation

Abstract

Several studies exist describing the biomechanical behavior of several external or internal fixation techniques of the posterior and anterior pelvic ring. Recently, the traditional models using isolated anatomical sections or fixed pelvic ring specimens for evaluation of linear or two-dimensional data have been replaced by three-dimensional measurement systems and simulations of muscle forces. These studies have contributed important information to the understanding of the biomechanics of the intact and injured pelvic ring, however, a consequent movement analysis is still missing. In the present study, 3-D data acquired during several series of testing implants for stabilization of the posterior pelvic ring (sacrum: sacral bars, sacral plates, transiliosacral lag screws; Sl joint: anterior plates, transiliosacral lag screws), using a complete pelvic ring model with single leg stance and static abductor muscle simulation, were converted into a commercially available 3-D animation package. By use of simple graphical representation of anatomical elements of the posterior pelvic ring, reproducible and reliable movement patterns for different types of stabilization could be identified, which demonstrated potential "weakness" of the fixation before failure occurred. These movements were analyzed by "replay functions" and were comparable to observations during the original experiment. The following movements were observed. Sacral fracture, transforaminal: (1) rotation of the transiliosacral lag screws around its axis, even with a second screw into S1; (2) Sacral bars: shearing with compression of the cranial-posterior fracture zone; (3) Sacral plates: minimal translation in the proximal fracture zone and distraction in the distal fracture line, effectively compensated by an additional plate at the S3 level. Sl joint disruption: (1) anterior plating (two plates), minimal translation in the plane of the Sl joint; (2) transiliosacral lag screws, rotational movement around the axis of the screws with only minimal movement at the S1 level. The provided information confirmed the observations and allowed a more detailed and comfortable examination of movement patterns. A better understanding of potential "failure zones" might be useful to optimize the dimensions, design, and the positioning of implants for the pelvic girdle. For further studies, more complex computer models including finite element technology might be useful to add accessory information and could result in a decreased need of living specimen testing.