title: Comparison of reconstruction plate screw fixation and percutaneous cannulated screw fixation in treatment of Tile B1 type pubic symphysis diastasis: a finite element analysis and 10-year clinical experience.
abstract: OBJECTIVE
  The objective of this study is to compare the biomechanical properties and clinical outcomes of Tile B1 type pubic symphysis diastasis (PSD) treated by percutaneous cannulated screw fixation (PCSF) and reconstruction plate screw fixation (RPSF).
  
  
  METHODS
  Finite element analysis (FEA) was used to compare the biomechanical properties between PCSF and RPSF. CT scan data of one PSD patient were used for three-dimensional reconstructions. After a validated pelvic finite element model was established, both PCSF and RPSF were simulated, and a vertical downward load of 600 N was loaded. The distance of pubic symphysis and stress were tested. Then, 51 Tile type B1 PSD patients (24 in the PCSF group; 27 in the RPSF group) were reviewed. Intra-operative blood loss, operative time, and the length of the skin scar were recorded. The distance of pubic symphysis was measured, and complications of infection, implant failure, and revision surgery were recorded. The Majeed scoring system was also evaluated.
  
  
  RESULTS
  The maximum displacement of the pubic symphysis was 0.408 and 0.643 mm in the RPSF and PCSF models, respectively. The maximum stress of the plate in RPSF was 1846 MPa and that of the cannulated screw in PCSF was 30.92 MPa. All 51 patients received follow-up at least 18 months post-surgery (range 18-54 months). Intra-operative blood loss, operative time, and the length of the skin scar in the PCSF group were significantly different than those in the RPSF group. No significant differences were found in wound infection, implant failure, rate of revision surgery, distance of pubic symphysis, and Majeed score.
  
  
  CONCLUSIONS
  PCSF can provide comparable biomechanical properties to RPSF in the treatment of Tile B1 type PSD. Meanwhile, PCSF and RPSF have similar clinical and radiographic outcomes. Furthermore, PCSF also has the advantages of being minimally invasive, has less blood loss, and has shorter operative time and skin scar.
authors.affiliation: Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jin Wu Wei Seventh Road, Jinan, 250021, Shandong, China. kehefish@163.com.
authors.forename: Ke-He
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang, 325000, China. hongmed@163.com.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Hong
authors.affiliation: Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang, 325000, China. drguoxiaoshao@163.com.
authors.forename: Xiao-Shan
authors.initials: XS
authors.lastname: Guo
authors.affiliation: Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jin Wu Wei Seventh Road, Jinan, 250021, Shandong, China. m15606778666@163.com.
authors.forename: Dong-Sheng
authors.initials: DS
authors.lastname: Zhou
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D020342:Finite Element Analysis; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D046548:Pubic Symphysis Diastasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult