JOURNAL ARTICLE

[Comparison of stability of sacroiliac screws in the treatment of bilateral sacral fractures in a finite element model]

Yong Zhao, Shu-Dong Zhang, Dan Wang, Yong-Hou Liu, Tao Sun, Chuan-Qiang Jiang, Jiang-Wei Tan, Wen-Qing Qu, Da-Jiang Xin
Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery] 2012, 50 (8): 719-23
23157905

OBJECTIVE: To compare the stability of sacroiliac screws fixation for the treatment of bilateral vertical sacral fractures to provide reference for clinic application.

METHODS: A finite element model of Tile C pelvic ring injury (bilateral type Denis II fracture of sacrum) was produced. The bilateral sacral fractures were fixed with sacroiliac screws in 4 types of models respectively: two bidirectional sacroiliac screws fixation in the S(1) segment, two bidirectional sacroiliac screws fixation in the S(2) segment, one sacroiliac screw fixation in the S(1) segment and one sacroiliac screw fixation in the S(2) segment, two bidirectional sacroiliac screws fixation in S(1) and S(2) segments respectively. By the ABAQUS 6.9.1 software, in the case of standing on both feet, 600 N vertical load was imitated to be imposed to the superior surface of the sacrum and downward translation and backward angle displacement of the middle part of the sacral superior surface and everted angle displacement of the top of iliac bones were extracted for analysis. The stability of sacroiliac screws fixation was compared according to the principle of the better stability the smaller displacement.

RESULTS: The stability of 2 bidirectional sacroiliac screws fixation in S(1) and S(2) segments respectively was markedly superior to that of 2 bidirectional sacroiliac screws fixation in S(1) or S(2) segment and was also markedly superior to that of one sacroiliac screw fixation in S(1) segment and one sacroiliac screw fixation in S(2) segment. The vertical and everted stability (the downward translation: 0.531 mm; the everted angle displacement: 0.156° (left side), 0.163° (right side)) of sacroiliac screws fixation in two bidirectional sacroiliac screws fixation in the S(2) segment was superior to that of two bidirectional sacroiliac screws fixation in the S(1) segment (the downward translation: 0.673 mm; the everted angle displacement: 0.200° (left side), 0.232° (right side)). The rotational stability of two bidirectional sacroiliac screws fixation in the S(1) segment (the backward angle displacement: 0.269°) was superior to that of two bidirectional sacroiliac screws fixation in the S(2) segment (the backward angle displacement: 0.287°). Moreover, the rotational stability of one sacroiliac screw fixation in the S(1) segment and one sacroiliac screw fixation in the S(2) segment was inferior to that of two bidirectional sacroiliac screws fixation in the S(1) segment or two bidirectional sacroiliac screws fixation in the S(2) segment, and the vertical and everted stability of one sacroiliac screw fixation in the S(1) segment and one sacroiliac screw fixation in the S(2) segment was between that of two bidirectional sacroiliac screws fixation in the S(1) segment and two bidirectional sacroiliac screws fixation in the S(2) segment.

CONCLUSIONS: Two bidirectional sacroiliac screws fixation in S(1) and S(2) segments respectively is recommended to be utilized for fixing bilateral sacral fractures of Tile C pelvic ring injury as far as possible. It is suggested to choose sacral segments in which sacroiliac screws fixed according to vertical, rotational and everted stability degree of sacral fractures.

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