Finite element analysis of five internal fixation modes in treatment of Day type<b>Ⅱ</b>crescent fracture dislocation of pelvis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PEI Xuan ^1,2 , HUANG Jincheng ³ ^△ , QIAN Shenglong ¹ , ZHOU Wei ^1,2 , KE Xi ¹ , WANG Guodong ¹ , LEI Jianyin ⁴ ,  LIU Ximing ^1,2,5

1. Department of Orthopedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;
2. School of Medicine, Wuhan University of Science and Technology, Wuhan Hubei, 430081, P. R. China;
3. Department of OrthopedicsⅡ, Affiliated Second People’s Hospital, China Three Gorges University, Yichang Hubei, 443000, P. R. China;
4. Taiyuan University of Technology, Taiyuan Shanxi, 030002, P. R. China;
5. Hubei University of Chinese Medicine, Wuhan Hubei, 430065, P. R. China;

Corresponding?author：

LIU Ximing, Email: gklxm@163.com

Keywords：

Crescent fracture dislocation of pelvis; internal fixation; finite element analysis; screw

DOI：

10.7507/1002-1892.202306043

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the biomechanical differences among the five internal fixation modes in treatment of Day type Ⅱ crescent fracture dislocation of pelvis (CFDP), and find an internal fixation mode which was the most consistent with mechanical principles. Methods Based on the pelvic CT data of a healthy adult male volunteer, a Day type Ⅱ CFDP finite element model was established by using Mimics 17.0, ANSYS 12.0-ICEM, Abaqus 2020, and SolidWorks 2012 softwares. After verifying the validity of the finite element model by comparing the anatomical parameters with the three-dimensional reconstruction model and the mechanical validity verification, the fracture and dislocated joint of models were fixed with S₁ sacroiliac screw combined with 1 LC-Ⅱ screw (S₁+LC-Ⅱ group), S₁ sacroiliac screw combined with 2 LC-Ⅱ screws (S₁+2LC-Ⅱ group), S₁ sacroiliac screw combined with 2 posterior iliac screws (S₁+2PIS group), S₁ and S₂ sacroiliac screws combined with 1 LC-Ⅱ screw (S₁+S₂+LC-Ⅱ group), S₂-alar-iliac (S₂AI) screw combined with 1 LC-Ⅱ screw (S₂AI+LC-Ⅱ group), respectively. After each internal fixation model was loaded with a force of 600 N in the standing position, the maximum displacement of the crescent fracture fragments, the maximum stress of the internal fixation (the maximum stress of the screw at the ilium fracture and the maximum stress of the screw at the sacroiliac joint), sacroiliac joint displacement, and bone stress distribution around internal fixation were observed in 5 groups. Results The finite element model in this study has been verified to be effective. After loading 600 N stress, there was a certain displacement of the crescent fracture of pelvis in each internal fixation model, among which the S₁+LC-Ⅱ group was the largest, the S₁+2LC-Ⅱ group and the S₁+2PIS group were the smallest. The maximum stress of the internal fixation mainly concentrated at the sacroiliac joint and the fracture line of crescent fracture. The maximum stress of the screw at the sacroiliac joint was the largest in the S₁+LC-Ⅱ group and the smallest in the S₂AI+LC-Ⅱ group. The maximum stress of the screw at the ilium fracture was the largest in the S₁+2PIS group and the smallest in the S₁+2LC-Ⅱ group. The displacement of the sacroiliac joint was the largest in the S₁+LC-Ⅱ group and the smallest in the S₁+S₂+LC-Ⅱ group. In each internal fixation model, the maximum stress around the sacroiliac screws concentrated on the contact surface between the screw and the cortical bone, the maximum stress around the screws at the iliac bone concentrated on the cancellous bone of the fracture line, and the maximum stress around the S₂AI screw concentrated on the cancellous bone on the iliac side. The maximum bone stress around the screws at the sacroiliac joint was the largest in the S₁+LC-Ⅱ group and the smallest in the S₂AI+LC-Ⅱ group. The maximum bone stress around the screws at the ilium was the largest in the S₁+2PIS group and the smallest in the S₁+LC-Ⅱ group. Conclusion For the treatment of Day type Ⅱ CFDP, it is recommended to choose S₁ sacroiliac screw combined with 1 LC-Ⅱ screw for internal fixation, which can achieve a firm fixation effect without increasing the number of screws.

Citation： PEI Xuan, HUANG Jincheng, QIAN Shenglong, ZHOU Wei, KE Xi, WANG Guodong, LEI Jianyin, LIU Ximing. Finite element analysis of five internal fixation modes in treatment of Day typeⅡcrescent fracture dislocation of pelvis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1205-1213. doi: 10.7507/1002-1892.202306043 Copy

1.	Day AC, Kinmont C, Bircher MD, et al. Crescent fracture-dislocation of the sacroiliac joint: a functional classification. J Bone Joint Surg (Br), 2007, 89(5): 651-658.
2.	Jatoi A, Sahito B, Kumar D, et al. Fixation of crescent pelvic fracture in a tertiary care hospital: a steep learning curve. Cureus, 2019, 11(9): e5614.
3.	Bachhal V, Jindal K, Rathod PM, et al. Bilateral crescent fracture-dislocation of the sacroiliac joint: a case-based discussion and review of literature. Int J Burns Trauma, 2021, 11(3): 260-266.
4.	Bansal H, Gupta A, Mittal S, et al. Concerns regarding biomechanical stability of different fixations models in crescent fracture dislocation. J Orthop Translat, 2020, 26: 181-182.
5.	馮永增, 董效禹, 項光恒, 等. 微創經皮交叉螺釘內固定治療Day Ⅱ型骨盆新月形骨折脫位的臨床療效研究. 中國現代醫生, 2020, 58(34): 80-84.
6.	袁毅, 王濤, 袁俊, 等. 經皮空心螺釘內固定術治療Day Ⅱ型骨盆新月型骨折. 中國修復重建外科雜志, 2018, 32(2): 139-144.
7.	水小龍, 翁益民, 馮永增, 等. 經皮螺釘內固定治療骨盆后方新月形骨折脫位. 中華創傷骨科雜志, 2015, 17(11): 921-925.
8.	Xiang G, Dong X, Jiang X, et al. Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type Ⅱ crescent fracture-dislocation: case-control study. J Orthop Surg Res, 2021, 16(1): 36.
9.	Shui XL, Ying XZ, Mao CW, et al. Percutaneous screw fixation of crescent fracture-dislocation of the sacroiliac joint. Orthopedics, 2015, 38(11): E976-E982.
10.	Li M, Huang D, Yan H, et al. Cannulated iliac screw fixation combined with reconstruction plate fixation for Day type Ⅱ crescent pelvic fractures. J Int Med Res, 2020, 48(1): 300060519896120.
11.	向杰, 范偉杰, 唐奕泉, 等. 經第2骶骨翼髂骨螺釘固定技術在不穩定型骨盆后環損傷治療中的應用效果分析. 中華創傷骨科雜志, 2022, 24(3): 206-212.
12.	Ikeda N, Fujibayashi S, Otsuki B, et al. The degenerative changes of the sacroiliac joint after S₂ alar-iliac screw placement. J Neurosurg Spine, 2021, 36(2): 1-7.
13.	文鵬飛, 李亞寧, 路玉峰, 等. 腰椎-骨盆-髖關節有限元模型建立及生物力學分析. 中國組織工程研究, 2023, 27(36): 5741-5746.
14.	葉海民, 鄒華春, 丁凌華, 等. 空心螺釘固定骶髂關節脫位的有限元分析. 中國組織工程研究, 2023, 27(13): 1993-1998.
15.	Song Y, Shao C, Yang X, et al. Biomechanical study of anterior and posterior pelvic rings using pedicle screw fixation for Tile C1 pelvic fractures: Finite element analysis. PLoS One, 2022, 17(8): e0273351.
16.	Phillips AT, Pankaj P, Howie CR, et al. Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions. Med Eng Phys, 2007, 29(7): 739-748.
17.	Zhu F, Bao HD, Yuan S, et al. Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population. Eur Spine J, 2013, 22(7): 1683-1689.
18.	Hedelin H, Brynskog E, Larnert P, et al. Postoperative stability following a triple pelvic osteotomy is affected by implant configuration: a finite element analysis. J Orthop Surg Res, 2022, 17(1): 275.
19.	郭東鴻, 童凱, 王鋼. 五種內固定方式固定髖臼后柱骨折生物力學特性的有限元分析. 中華創傷骨科雜志, 2020, 22(6): 529-535.
20.	Zhang L, Peng Y, Du C, et al. Biomechanical study of four kinds of percutaneous screw fixation in two types of unilateral sacroiliac joint dislocation: a finite element analysis. Injury, 2014, 45(12): 2055-2059.
21.	馮永增. 五種內固定方式用于DayⅡ型骨盆新月形骨折脫位的生物力學和臨床對比研究. 廣州: 南方醫科大學, 2017.
22.	Cai L, Zhang Y, Zheng W, et al. A novel percutaneous crossed screws fixation in treatment of Day type Ⅱ crescent fracture-dislocation: A finite element analysis. J Orthop Translat, 2019, 20: 37-46.
23.	孟歡, 林光湖, 馮小仍, 等. 經第二骶椎髂骨翼螺釘和骶髂關節螺釘治療C型骶髂關節脫位的有限元對比研究. 中華創傷雜志, 2018, 34(6): 505-512.
24.	高應超, 郭征, 付軍, 等. 坐位骨盆的三維有限元分析. 中國組織工程研究與臨床康復, 2011, 15(22): 3997-4001.
25.	裴璇, 錢勝龍, 周唯, 等. 導航下經皮空心螺釘與后路經皮重建鋼板內固定治療DayⅡ型骨盆新月形骨折脫位的療效比較. 中華創傷雜志, 2022, 38(6): 551-557.

1. Day AC, Kinmont C, Bircher MD, et al. Crescent fracture-dislocation of the sacroiliac joint: a functional classification. J Bone Joint Surg (Br), 2007, 89(5): 651-658.
2. Jatoi A, Sahito B, Kumar D, et al. Fixation of crescent pelvic fracture in a tertiary care hospital: a steep learning curve. Cureus, 2019, 11(9): e5614.
3. Bachhal V, Jindal K, Rathod PM, et al. Bilateral crescent fracture-dislocation of the sacroiliac joint: a case-based discussion and review of literature. Int J Burns Trauma, 2021, 11(3): 260-266.
4. Bansal H, Gupta A, Mittal S, et al. Concerns regarding biomechanical stability of different fixations models in crescent fracture dislocation. J Orthop Translat, 2020, 26: 181-182.
5. 馮永增, 董效禹, 項光恒, 等. 微創經皮交叉螺釘內固定治療Day Ⅱ型骨盆新月形骨折脫位的臨床療效研究. 中國現代醫生, 2020, 58(34): 80-84.
6. 袁毅, 王濤, 袁俊, 等. 經皮空心螺釘內固定術治療Day Ⅱ型骨盆新月型骨折. 中國修復重建外科雜志, 2018, 32(2): 139-144.
7. 水小龍, 翁益民, 馮永增, 等. 經皮螺釘內固定治療骨盆后方新月形骨折脫位. 中華創傷骨科雜志, 2015, 17(11): 921-925.
8. Xiang G, Dong X, Jiang X, et al. Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type Ⅱ crescent fracture-dislocation: case-control study. J Orthop Surg Res, 2021, 16(1): 36.
9. Shui XL, Ying XZ, Mao CW, et al. Percutaneous screw fixation of crescent fracture-dislocation of the sacroiliac joint. Orthopedics, 2015, 38(11): E976-E982.
10. Li M, Huang D, Yan H, et al. Cannulated iliac screw fixation combined with reconstruction plate fixation for Day type Ⅱ crescent pelvic fractures. J Int Med Res, 2020, 48(1): 300060519896120.
11. 向杰, 范偉杰, 唐奕泉, 等. 經第2骶骨翼髂骨螺釘固定技術在不穩定型骨盆后環損傷治療中的應用效果分析. 中華創傷骨科雜志, 2022, 24(3): 206-212.
12. Ikeda N, Fujibayashi S, Otsuki B, et al. The degenerative changes of the sacroiliac joint after S₂ alar-iliac screw placement. J Neurosurg Spine, 2021, 36(2): 1-7.
13. 文鵬飛, 李亞寧, 路玉峰, 等. 腰椎-骨盆-髖關節有限元模型建立及生物力學分析. 中國組織工程研究, 2023, 27(36): 5741-5746.
14. 葉海民, 鄒華春, 丁凌華, 等. 空心螺釘固定骶髂關節脫位的有限元分析. 中國組織工程研究, 2023, 27(13): 1993-1998.
15. Song Y, Shao C, Yang X, et al. Biomechanical study of anterior and posterior pelvic rings using pedicle screw fixation for Tile C1 pelvic fractures: Finite element analysis. PLoS One, 2022, 17(8): e0273351.
16. Phillips AT, Pankaj P, Howie CR, et al. Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions. Med Eng Phys, 2007, 29(7): 739-748.
17. Zhu F, Bao HD, Yuan S, et al. Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population. Eur Spine J, 2013, 22(7): 1683-1689.
18. Hedelin H, Brynskog E, Larnert P, et al. Postoperative stability following a triple pelvic osteotomy is affected by implant configuration: a finite element analysis. J Orthop Surg Res, 2022, 17(1): 275.
19. 郭東鴻, 童凱, 王鋼. 五種內固定方式固定髖臼后柱骨折生物力學特性的有限元分析. 中華創傷骨科雜志, 2020, 22(6): 529-535.
20. Zhang L, Peng Y, Du C, et al. Biomechanical study of four kinds of percutaneous screw fixation in two types of unilateral sacroiliac joint dislocation: a finite element analysis. Injury, 2014, 45(12): 2055-2059.
21. 馮永增. 五種內固定方式用于DayⅡ型骨盆新月形骨折脫位的生物力學和臨床對比研究. 廣州: 南方醫科大學, 2017.
22. Cai L, Zhang Y, Zheng W, et al. A novel percutaneous crossed screws fixation in treatment of Day type Ⅱ crescent fracture-dislocation: A finite element analysis. J Orthop Translat, 2019, 20: 37-46.
23. 孟歡, 林光湖, 馮小仍, 等. 經第二骶椎髂骨翼螺釘和骶髂關節螺釘治療C型骶髂關節脫位的有限元對比研究. 中華創傷雜志, 2018, 34(6): 505-512.
24. 高應超, 郭征, 付軍, 等. 坐位骨盆的三維有限元分析. 中國組織工程研究與臨床康復, 2011, 15(22): 3997-4001.
25. 裴璇, 錢勝龍, 周唯, 等. 導航下經皮空心螺釘與后路經皮重建鋼板內固定治療DayⅡ型骨盆新月形骨折脫位的療效比較. 中華創傷雜志, 2022, 38(6): 551-557.

Chinese Journal of Reparative and Reconstructive Surgery

Finite element analysis of five internal fixation modes in treatment of Day typeⅡcrescent fracture dislocation of pelvis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content