Comparison of Modified Transiliac Internal Fixators: Mechanical Testing on Pelvic Models

PURPOSE OF THE STUDY Vertically unstable transforaminal sacral fractures can be stabilized with several types of transiliac internal fixators (TIFI): the classical one (TIFI-C), the supraacetabular one (TIFI-A) and by dual application of TIFI (DTIFI). MATERIAL AND METHODS Pelvic models made of solid foam (Sawbones 1301) were used in the study. Mechanical loading tests were performed in order to assess the stiffness of the studied pelvic structures. The stiffness of the intact model was approximated as the slope of load/displacement curve. Then vertically unstable right-sided linear transforaminal fracture was created and subsequently fixed by TIFI-C, TIFI-A and DTIFI (each fixator for a separate model). The fixation techniques were compared based on the ratio between the stiffness of the treated and of the intact pelvis. Motion of the posterior pelvic structures and their deformations were measured using a photogrammetric system with four synchronous cameras. Loads applied at the base of sacrum and sacral base displacements were recorded by the testing device and used to assess the stiffness of the model structure. A dedicated load cell and a monoaxial extensometer were utilised. Every measurement was repeated at least 10 times. Obtained data were analysed by one way ANOVA test with post hoc comparison by Tukey HSD test. RESULTS Mean stiffness ratio (±1SD) of pelvic structure was 0.638 ± 0.005 for TIFI-C, 0.722 ± 0.014 for TIFI-A and 0.720 ± 0.008 for DTIFI. Dual transiliac internal fixation and supraacetabular fixation were superior to the classical one (p < 0.0001), but DTIFI and TIFI-A stiffness ratios were statistically equivalent (p = 0.9112). CONCLUSIONS Results of the mechanical analysis using pelvic models indicate that for linear vertical transforaminal sacral fracture without comminuted zone, an application of either TIFI-A or DTIFI provides significantly higher stiffness of the lateral pelvic segment than application of TIFI-C. Key words: transforaminal sacral fracture, transiliac internal fixator, dual TIFI, stability, biomechanics, digital image correlation.