title: The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries--A computer study to gain insight into open book trauma.
abstract: Surgical stabilization of the pelvis following type II anteroposterior compression pelvic injuries (APCII) is based on the assumption that the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments disrupt simultaneously. Recent data on the ligaments contradict this concept. We aimed at determining the mechanisms of ligament failure in APCII computationally. In an individual osteoligamentous computer model of the pelvis, ligament load, and strain were observed for the two-leg stance, APCII with 100-mm symphyseal widening and for two-leg stance with APCII-related ligament failure, and validated with body donors. The anterior sacroiliac and sacrotuberous ligaments had the greatest load with 80% and 17% of the total load, respectively. APCII causes partial failure of the anterior sacroiliac ligament and the pelvis to become horizontally instable. The other ligaments remained intact. The sacrospinous ligament was negligibly loaded but stabilized the pelvis vertically. The interosseous sacroiliac and sacrotuberous ligaments are likely responsible for reducing the symphysis and might serve as an indicator of vertical stability. The sacrospinous ligament appears to be of minor significance in APCII but plays an important role in vertical stabilization. Further research is necessary to determine the influence of alterations in ligament and bone material properties.
authors.affiliation: Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Böhme
authors.forename: Uwe
authors.initials: U
authors.lastname: Lingslebe
authors.forename: Hanno
authors.initials: H
authors.lastname: Steinke
authors.forename: Michael
authors.initials: M
authors.lastname: Werner
authors.forename: Volker
authors.initials: V
authors.lastname: Slowik
authors.forename: Christoph
authors.initials: C
authors.lastname: Josten
authors.forename: Niels
authors.initials: N
authors.lastname: Hammer
mesh_terms: D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002356:Cartilage / Q000473:pathology; D003198:Computer Simulation; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D008022:Ligaments / Q000293:injuries* / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries; D008297:Male; D008953:Models, Anatomic; D010384:Pelvic Bones / Q000293:injuries*; D010388:Pelvis / Q000293:injuries* / Q000601:surgery*; D011631:Pubic Symphysis / Q000293:injuries*; D012446:Sacroiliac Joint / Q000293:injuries*; D012984:Software; D013314:Stress, Mechanical
keywords: anterior compression pelvic injury; finite element computer study; pelvic biomechanics; pubic symphysis widening; sacroiliac joint ligaments