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Purpose <p>This study aimed to biomechanically evaluate various minimally invasive combination fixation methods for Tile C pelvic fractures, specifically assessing the efficacy of different anterior ring fixation techniques combined with short sacroiliac screw placement at either the S1 or S2 segment.</p> Methods <p>Eight finite element models of a Tile C pelvic injury (unilateral Denis zone II sacral fracture with bilateral pubic rami fractures) were constructed. The models simulated four anterior fixation techniques—percutaneous retrograde cannulated screw, minimally invasive percutaneous plate, retrograde superior pubic ramus intramedullary nail, and internal fixator (INFIX)—each combined with a short sacroiliac screw in either the S1 or S2 segment. Biomechanical performance was assessed under vertical, transverse, and lateral compression loads by measuring implant stress, overall pelvic displacement, and fracture fragment displacement.</p> Results <p>The results indicated that INFIX combined with S1 or S2 screws yielded the lowest maximum implant stress. For fracture stability, plate and intramedullary nail fixations with S1or S2 screws provided the least sagittal sacral displacement, while cannulated screws with S1 or S2 screws minimized pubic fragment displacement. Regarding overall pelvic stability, the S1 screw was most effective when paired with a cannulated screw or plate. Conversely, the S2 screw performed poorly with an intramedullary nail or cannulated screw but effectively with a plate or INFIX for correcting pelvic deformity.</p> Conclusion <p>The study concludes that retrograde superior pubic ramus intramedullary nailing combined with a short S1 or S2 sacroiliac screw is a promising technique, demonstrating favorable overall biomechanical performance for the fixation of Tile C pelvic fractures.</p>

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Biomechanical Evaluation of Different Minimally Invasive Internal Fixation Methods for the Anterior and Posterior Rings in Tile C Pelvic Fractures

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Xin Rao,
  • Daixiang Jiang,
  • Hui Lu,
  • Yangxing Luo,
  • Dingxi Liu,
  • Yuanfeng Liu,
  • Lei yin,
  • Rong Liu

摘要

Purpose

This study aimed to biomechanically evaluate various minimally invasive combination fixation methods for Tile C pelvic fractures, specifically assessing the efficacy of different anterior ring fixation techniques combined with short sacroiliac screw placement at either the S1 or S2 segment.

Methods

Eight finite element models of a Tile C pelvic injury (unilateral Denis zone II sacral fracture with bilateral pubic rami fractures) were constructed. The models simulated four anterior fixation techniques—percutaneous retrograde cannulated screw, minimally invasive percutaneous plate, retrograde superior pubic ramus intramedullary nail, and internal fixator (INFIX)—each combined with a short sacroiliac screw in either the S1 or S2 segment. Biomechanical performance was assessed under vertical, transverse, and lateral compression loads by measuring implant stress, overall pelvic displacement, and fracture fragment displacement.

Results

The results indicated that INFIX combined with S1 or S2 screws yielded the lowest maximum implant stress. For fracture stability, plate and intramedullary nail fixations with S1or S2 screws provided the least sagittal sacral displacement, while cannulated screws with S1 or S2 screws minimized pubic fragment displacement. Regarding overall pelvic stability, the S1 screw was most effective when paired with a cannulated screw or plate. Conversely, the S2 screw performed poorly with an intramedullary nail or cannulated screw but effectively with a plate or INFIX for correcting pelvic deformity.

Conclusion

The study concludes that retrograde superior pubic ramus intramedullary nailing combined with a short S1 or S2 sacroiliac screw is a promising technique, demonstrating favorable overall biomechanical performance for the fixation of Tile C pelvic fractures.