Internal fixation of the unstable anterior pelvic ring: a biomechanical comparison of standard plating techniques and the retrograde medullary superior pubic ramus screw.

@article{Simonian1994InternalFO,
  title={Internal fixation of the unstable anterior pelvic ring: a biomechanical comparison of standard plating techniques and the retrograde medullary superior pubic ramus screw.},
  author={Peter T. Simonian and Milton Lee Chip Routt and Rebecca M. Harrington and Allan F. Tencer},
  journal={Journal of orthopaedic trauma},
  year={1994},
  volume={8 6},
  pages={476-82}
}
The purpose of this study was to evaluate pubic ramus fracture fixation. This biomechanical evaluation compared standard plating techniques with retrograde medullary screw fixation of a superior pubic ramus fracture in a pelvic fracture model. Six fresh-frozen, cadaveric pelvic specimens with a mean age of 79 years were harvested. These specimens were physiologically loaded according to the following modifications and instrumentations: (a) intact; (b) an APC-II unstable pelvic injury… CONTINUE READING

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These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
These specimens were physiologically loaded according to the following modifications and instrumentations : ( a ) intact ; ( b ) an APC - II unstable pelvic injury , specifically , unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac ( SI ) joint , sacrospinous , and sacrotuberous ligamentous disruptions , without fixation ; ( c ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws ; ( d ) disrupted as in ( b ) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws ; ( e ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long ( medial to the hip joint ) ; and ( f ) disrupted as in ( b ) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint .
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