| Institution: | 1. Department of Orthopaedic Surgery, Medical College of Wisconsin, United States;2. Medical College of Wisconsin, United States;3. Floyd Medical Center Orthoapedic Trauma Surgery, United States;1. Department of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada;2. Memorial University, Division of Orthopedic Surgery, Health Science Center, St. John''s, Newfoundland, Canada;3. University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1;1. University of Queensland, Brisbane, QLD, Australia;2. Mater Hospital, South Brisbane, QLD, Australia;1. MSk Lab, Imperial College London, London, UK;2. Trauma & Orthopaedic Surgery Unit, Imperial College Healthcare NHS Trust, UK;3. Medical Data Research Collaborative, London W2 1NY, UK;4. Department of Trauma & Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, UK;5. Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK;6. Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK;7. Brigham and Women''s Hospital, Boston, MA, USA;8. National Heart and Lung Institute, Imperial College London, London, UK;9. Department of Ear, Nose and Throat, Head and Neck Surgery, St Georges University Hospitals NHS Trust, London, UK;10. Department of Trauma Orthopaedics, London North West University NHS Trust, UK;11. Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK;1. University of Central Florida College of Medicine 6850 Lake Nona Blvd, Orlando, FL 32827 United States;2. University of Central Florida Department of Mechanical and Aerospace Engineering 2760 Pegasus Dr, Orlando, FL 32816 United States |
| Abstract: | PurposePelvic fractures are associated with high morbidity and often require surgical intervention. An Anterior Posterior Compression (APC) II injury consists of disruption at the pubic symphysis and anterior sacroiliac joint. Studies investigating specific ligamentous contributions would aid in development of novel fixation techniques. The objective of this study is to determine the level of pelvic destabilization from progressive soft tissue disruptions associated with APC II injuries.MethodsSix fresh-frozen cadaveric pelvises were dissected of soft tissues, preserving joint capsules and ligaments. Each pelvis was secured in a double-leg stance and joint motion was tracked with the specimens cyclically loaded to 60% body weight. Each specimen was measured in the intact state and again following stepwise destabilization to an APC II injury model (PS: sectioned pubic symphysis, IPS JOINT: PS + ipsilateral anterior sacroiliac, sacrotuberous, sacrospinous ligaments sectioned, IPS LIGS: IPS JOINT + ipsilateral interosseous ligaments sectioned, IPS JOINT+CONT ASI: IPS LIGS + contralateral anterior sacroiliac ligament disruption).ResultsCompared to the intact state, there was a statistically significant increase in movement in the IPS JOINT (ipsilateral 177%, p<0.001; contralateral 46%, p<0.005) and IPS JOINT+CONT ASI (ipsilateral 184%, p<0.002; and contralateral 62%, p<0.002) states bilaterally. No significant change was demonstrated in the PS or IPS LIGS state.ConclusionDisruption of ipsilateral ligamentous structures destabilized both sacroiliac joints. The interosseous and posterior sacroiliac ligaments provide the majority of stability of the sacroiliac joint and will likely benefit most from surgical stabilization.Level of Evidencemechanism-based reasoning. |
