Abstract
Background: Fractures of the four anterior pubic rami are described as “straddle fractures”. The aim of this study was to compare biomechanical anterior plating (group 1) versus the bilateral use of retrograde transpubic screws (group 2). Methods: A straddle fracture was simulated in 16 artificial pelvises. All specimens were tested under progressively increasing cyclic loading, with monitoring by means of motion tracking. Results: Axial stiffness did not differ significantly between the groups, p = 0.88. Fracture displacement after 1000–4000 cycles was not significantly different between the groups, p ≥ 0.38; however, after 5000 cycles it was significantly less in the retrograde transpubic screw group compared to the anterior plating group, p = 0.04. No significantly different flexural rotations were detected between the groups, p ≥ 0.32. Moreover, no significant differences were detected between the groups with respect to their cycles to failure and failure loads, p = 0.14. Conclusion: The results of this biomechanical study reveal less fracture displacement in the retrograde transpubic screw group after long-term testing with no further significant difference between anterior plating and bilateral use of retrograde transpubic screws. While the open approach using anterior plating allows for better visualization of the fracture site and open reduction, the use of bilateral retrograde transpubic screws, splinting the fracture, presents a minimally invasive and biomechanically stable technique.
Highlights
Introduction published maps and institutional affilFractures of the four anterior pubic rami of the pelvis, classified as “straddle” or “butterfly” fractures, were first described by Dunn and Morris [1]
According to the AO/OTA classification, straddle fractures with an intact posterior pelvic ring are classified as type 61A2.3 [9]
The aim of the present study was to investigate the biomechanical competence of anterior plating versus the bilateral use of retrograde transpubic screws for the treatment of straddle pelvic ring fractures
Summary
Fractures of the four anterior pubic rami of the pelvis, classified as “straddle” or “butterfly” fractures, were first described by Dunn and Morris [1]. Their typical mechanism implements anterior to posterior or lateral compression forces [2,3,4]. Pelvic ring fractures, caused by high energy trauma, often result in severe bleeding and complications because of the high-volume blood supply of the pelvis and injuries of the internal organs [5,6]. Fracture displacement after 1000–4000 cycles was not significantly different between the groups, p ≥ 0.38; after 5000 cycles it was significantly less in the retrograde transpubic screw group compared to the anterior plating group, p = 0.04.
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