Achievable pin spanning angulation in anterosuperior pelvic external fixation
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ORIGINAL ARTICLE
Achievable pin spanning angulation in anterosuperior pelvic external fixation Benjamin Young1 · Drayton Daily1 · Clarence Kee1 · Kevin Perry1 · Massimo Max Morandi1 · R. Shane Barton1 · Giovanni F. Solitro1 Received: 12 March 2020 / Accepted: 22 April 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Introduction Pelvic external fixation using anterosuperior pins provides a quick method of stabilization without necessitating fluoroscopic guidance. Various locations, depths, and inclinations have been cited for external fixator pins; however, the existing literature lacks clear indications for the angular difference between pins. Thus, we aimed to determine the greatest degree of sagittal pin spanning angulation (SPSA) between two iliac crest pins and how intraosseous depth (ID) affects these angulations. Materials and methods A newly developed computer algorithm produced cross sections of 3D pelvic reconstructions in the sagittal plane in 5° increments. Computer-generated pins with IDs of 60, 75, and 90 mm were positioned in 5° increments transversely. Pins were assessed for cortical containment to define values for SPSA and transverse pin spanning angulation (TPSA). Results A bimodal distribution revealed varying degrees of insertion frequency and SPSA, cranially and caudally. The caudal distribution exhibited greater cortical containment with larger values for SPSA and TPSA. The highest insertion frequency (85.7%) and largest SPSA (155°) were observed for the 60-mm ID. Increasing ID resulted in further bony penetration and smaller values for SPSA and TPSA. Conclusions Expanding the degree of SPSA between inserted pins in anterosuperior pelvic external fixation can be challenging due to the thinning of the iliac wing, which affords a narrow corridor for intraosseous pin containment. An ID of 60 mm allows larger degrees of SPSA while maintaining higher rates of cortical pin containment when compared to pins with greater IDs. Keywords Anterosuperior · External fixation · Pelvis · Trauma · Stabilization · Biomechanical stability
Introduction Pelvic fractures represent one of the most common injuries resulting from high-energy trauma and necessitate remarkably complex management [1]. This subset of orthopedic injuries is coupled with a significantly higher incidence of patient morbidity and is found in nearly 20% of polytrauma patients [2, 3]. Mortality rates in these patients vary considerably between 4 and 34% [4]. External fixation has been used for over 50 years to provide temporary or definitive * Giovanni F. Solitro [email protected] 1
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, USA
stability of displaced pelvic rings [3, 5] and aid in the effective management of such injuries [6]. External fixation lowers the incidence of nerve injury, controls bleeding, reduces fractures, and allows patient mobility [7, 8]. The anterosuperior, supraacetabular, and subcristal techni
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