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Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

INTRODUCTION: Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. The...

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Autores principales: Cavalcanti Kußmaul, Adrian, Schwaabe, Fanny, Kistler, Manuel, Gennen, Clara, Andreß, Sebastian, Becker, Christopher A., Böcker, Wolfgang, Greiner, Axel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9381629/
https://www.ncbi.nlm.nih.gov/pubmed/34052913
http://dx.doi.org/10.1007/s00402-021-03968-z
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author Cavalcanti Kußmaul, Adrian
Schwaabe, Fanny
Kistler, Manuel
Gennen, Clara
Andreß, Sebastian
Becker, Christopher A.
Böcker, Wolfgang
Greiner, Axel
author_facet Cavalcanti Kußmaul, Adrian
Schwaabe, Fanny
Kistler, Manuel
Gennen, Clara
Andreß, Sebastian
Becker, Christopher A.
Böcker, Wolfgang
Greiner, Axel
author_sort Cavalcanti Kußmaul, Adrian
collection PubMed
description INTRODUCTION: Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge(™)) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. MATERIALS AND METHODS: Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge(™) in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. RESULTS: Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge(™) techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). CONCLUSIONS: Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge(™) as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior.
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spelling pubmed-93816292022-08-18 Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study Cavalcanti Kußmaul, Adrian Schwaabe, Fanny Kistler, Manuel Gennen, Clara Andreß, Sebastian Becker, Christopher A. Böcker, Wolfgang Greiner, Axel Arch Orthop Trauma Surg Trauma Surgery INTRODUCTION: Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge(™)) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. MATERIALS AND METHODS: Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge(™) in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. RESULTS: Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge(™) techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). CONCLUSIONS: Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge(™) as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior. Springer Berlin Heidelberg 2021-05-29 2022 /pmc/articles/PMC9381629/ /pubmed/34052913 http://dx.doi.org/10.1007/s00402-021-03968-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Trauma Surgery
Cavalcanti Kußmaul, Adrian
Schwaabe, Fanny
Kistler, Manuel
Gennen, Clara
Andreß, Sebastian
Becker, Christopher A.
Böcker, Wolfgang
Greiner, Axel
Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
title Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
title_full Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
title_fullStr Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
title_full_unstemmed Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
title_short Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
title_sort novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study
topic Trauma Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9381629/
https://www.ncbi.nlm.nih.gov/pubmed/34052913
http://dx.doi.org/10.1007/s00402-021-03968-z
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