Trans-obturator cable fixation of open book pelvic injuries

Martin C Jordan,Veronika Jäckle,Stefanie Hölscher-Doht,Timo M Heintel,Sebastian Scheidt,Rainer H Meffert,Süleyman Ergün,Fabian Gilbert

doi:10.1038/s41598-021-92755-2

Abstract

Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

Highlights

Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications
Disruption of the pubic symphysis is commonly seen in pelvic ring injuries of trauma p atients[1,2]
The disruption of the anterior pelvic ring might occur in combination with a posterior pelvic ring impairment of variable severity

Summary

Introduction

Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. When diastasis of the disrupted symphysis pubis exceeds a certain displacement, stabilization of the anterior pelvic ring is recommended[3,4]. Symphyseal plating represents the most common technique for anterior pelvic ring fixation in such conditions[6]. This plate fixation, ; represents a static fixation of what is a dynamic junction. The aim of this study is to analyze dynamic transobturator cable fixation as an alternative stabilization for the disrupted pubic symphysis. The cable fixation could be a dynamic, less invasive alternative to symphyseal plating with less complications

Objectives

Results

Conclusion