Abstract
BackgroundFive different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics.MethodsDenis type I sacral fractures were created by FE modeling. Five different fixation methods for the posterior pelvic ring were simulated: sacroiliac screw (SIS), lumbopelvic fixation (LPF), transiliac internal fixator (TIFI), S2-alar-iliac (S2AI) screw and S1 pedicle screw fixation (S2AI-S1) and S2AI screw and contralateral S1 pedicle screw fixation (S2AI-CS1). Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending and left twisting, respectively. Vertical stiffness, relative displacement and change in relative displacement were recorded and analyzed.ResultsAs predicted by the FE model, the vertical stiffness of the five groups in descending order was S2AI-S1, SIS, S2AI-CS1, LPF and TIFI. In terms of relative displacement, groups S2AI-S1 and S2AI-CS1 displayed a lower mean relative displacement, although group S2AI-CS1 exhibited greater displacement in the upper sacrum than group S2AI-S1. Group SIS displayed a moderate mean relative displacement, although the displacement of the upper sacrum was smaller than the corresponding displacement in group S2AI-CS1, while groups LPF and TIFI displayed larger mean relative displacements. Finally, in terms of change in relative displacement, groups TIFI and LPF displayed the greatest fluctuations in their motion, while groups SIS, S2AI-S1 and S2AI-CS1 displayed smaller fluctuations.ConclusionCompared with SIS, unilateral LPF and TIFI, group S2AI-S1 displayed the greatest biomechanical stability of the Denis type I sacral fracture FE models. When the S1 pedicle screw insertion point on the affected side is damaged, S2AI-CS1 can be used as an appropriate alternative to S2AI-S1.
Highlights
Five different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics
We propose the S2AI screw and the ipsilateral S1 pedicle screw fixation (S2AI-S1) as a new internal fixation method to address problems in lumbopelvic fixation (LPF), such as high invasiveness to soft tissue, the limitations to the mobility of lumbar vertebrae and adjacent segment disease [15]
The aim of this study was to investigate the biomechanical stability of S2AI-S1, S2AI-CS1, Sacroiliac screws (SIS), LPF and transiliac internal fixators (TIFI) for the treatment of non-osteoporotic sacral fractures (Denis type I) through finite element (FE) analysis
Summary
Five different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics. Sacroiliac screws (SIS), lumbopelvic fixation (LPF) and transiliac internal fixators (TIFI) have been widely used clinically as the three conventional methods of posterior pelvic ring injury treatment. Zheng et al J Orthop Surg Res (2021) 16:651 the clinical practice of LPF, such as incision infection, screw prominence and implant failure [3, 4]. Long-term fixation of the lumbar vertebrae increases the likelihood of lower back discomfort [4]. TIFI has the advantages of being minimally invasive and displays a low postoperative infection rate, it still cannot prevent local skin discomfort caused by screw protrusion [5]
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