Biomechanical Effects of a Cross Connector in Sacral Fractures

A Finite Element Analysis

verfasst von
Meike Gierig, Fangrui Liu, Lukas Weiser, Wolfgang Lehmann, Peter Wriggers, Michele Marino, Dominik Saul
Abstract

Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.

Organisationseinheit(en)
Institut für Kontinuumsmechanik
Externe Organisation(en)
Georg-August-Universität Göttingen
Università degli studi di Roma Tor Vergata
Mayo Clinic Rochester MN
Typ
Artikel
Journal
Frontiers in Bioengineering and Biotechnology
Band
9
Publikationsdatum
26.05.2021
Publikationsstatus
Veröffentlicht
Peer-reviewed
Ja
ASJC Scopus Sachgebiete
Biotechnologie, Bioengineering, Histologie, Biomedizintechnik
Elektronische Version(en)
https://doi.org/10.3389/fbioe.2021.669321 (Zugang: Offen)
 

Details im Forschungsportal „Research@Leibniz University“