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

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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.	冯永增, 董效禹, 项光恒, 等. 微创经皮交叉螺钉内固定治疗Day Ⅱ型骨盆新月形骨折脱位的临床疗效研究. 中国现代医生, 2020, 58(34): 80-84.
6.	袁毅, 王涛, 袁俊, 等. 经皮空心螺钉内固定术治疗Day Ⅱ型骨盆新月型骨折. 中国修复重建外科杂志, 2018, 32(2): 139-144.
7.	水小龙, 翁益民, 冯永增, 等. 经皮螺钉内固定治疗骨盆后方新月形骨折脱位. 中华创伤骨科杂志, 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, 范伟杰, 唐奕泉, 等. 经第2骶骨翼髂骨螺钉固定技术在不稳定型骨盆后环损伤治疗中的应用效果分析. 中华创伤骨科杂志, 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.	文鹏飞, 李亚宁, 路玉峰, 等. 腰椎-骨盆-髋关节有限元模型建立及生物力学分析. 中国组织工程研究, 2023, 27(36): 5741-5746.
14.	叶海民, 邹华春, 丁凌华, 等. 空心螺钉固定骶髂关节脱位的有限元分析. 中国组织工程研究, 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.	郭东鸿, 童凯, 王钢. 五种内固定方式固定髋臼后柱骨折生物力学特性的有限元分析. 中华创伤骨科杂志, 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.	冯永增. 五种内固定方式用于DayⅡ型骨盆新月形骨折脱位的生物力学和临床对比研究. 广州: 南方医科大学, 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.	孟欢, 林光湖, 冯小仍, 等. 经第二骶椎髂骨翼螺钉和骶髂关节螺钉治疗C型骶髂关节脱位的有限元对比研究. 中华创伤杂志, 2018, 34(6): 505-512.
24.	高应超, 郭征, 付军, 等. 坐位骨盆的三维有限元分析. 中国组织工程研究与临床康复, 2011, 15(22): 3997-4001.
25.	裴璇, 钱胜龙, 周唯, 等. 导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位的疗效比较. 中华创伤杂志, 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. 冯永增, 董效禹, 项光恒, 等. 微创经皮交叉螺钉内固定治疗Day Ⅱ型骨盆新月形骨折脱位的临床疗效研究. 中国现代医生, 2020, 58(34): 80-84.
6. 袁毅, 王涛, 袁俊, 等. 经皮空心螺钉内固定术治疗Day Ⅱ型骨盆新月型骨折. 中国修复重建外科杂志, 2018, 32(2): 139-144.
7. 水小龙, 翁益民, 冯永增, 等. 经皮螺钉内固定治疗骨盆后方新月形骨折脱位. 中华创伤骨科杂志, 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, 范伟杰, 唐奕泉, 等. 经第2骶骨翼髂骨螺钉固定技术在不稳定型骨盆后环损伤治疗中的应用效果分析. 中华创伤骨科杂志, 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. 文鹏飞, 李亚宁, 路玉峰, 等. 腰椎-骨盆-髋关节有限元模型建立及生物力学分析. 中国组织工程研究, 2023, 27(36): 5741-5746.
14. 叶海民, 邹华春, 丁凌华, 等. 空心螺钉固定骶髂关节脱位的有限元分析. 中国组织工程研究, 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. 郭东鸿, 童凯, 王钢. 五种内固定方式固定髋臼后柱骨折生物力学特性的有限元分析. 中华创伤骨科杂志, 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. 冯永增. 五种内固定方式用于DayⅡ型骨盆新月形骨折脱位的生物力学和临床对比研究. 广州: 南方医科大学, 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. 孟欢, 林光湖, 冯小仍, 等. 经第二骶椎髂骨翼螺钉和骶髂关节螺钉治疗C型骶髂关节脱位的有限元对比研究. 中华创伤杂志, 2018, 34(6): 505-512.
24. 高应超, 郭征, 付军, 等. 坐位骨盆的三维有限元分析. 中国组织工程研究与临床康复, 2011, 15(22): 3997-4001.
25. 裴璇, 钱胜龙, 周唯, 等. 导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位的疗效比较. 中华创伤杂志, 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

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