Biomechanical Effects of a Cross Connector in Sacral Fractures – A Finite Element Analysis

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Gierig, M.; Liu, F.; Weiser, L.; Lehmann, W.; Wriggers, P. et al.: Biomechanical Effects of a Cross Connector in Sacral Fractures – A Finite Element Analysis. In: Frontiers in Bioengineering and Biotechnology 9 (2021), 669321. DOI: https://doi.org/10.3389/fbioe.2021.669321

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To cite the version in the repository, please use this identifier: https://doi.org/10.15488/12416

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Abstract: 
Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant. © Copyright © 2021 Gierig, Liu, Weiser, Lehmann, Wriggers, Marino and Saul.
License of this version: CC BY 4.0 Unported
Document Type: Article
Publishing status: publishedVersion
Issue Date: 2021
Appears in Collections:Fakultät für Maschinenbau

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1 image of flag of Germany Germany 37 59.68%
2 image of flag of United States United States 16 25.81%
3 image of flag of China China 6 9.68%
4 image of flag of Taiwan Taiwan 1 1.61%
5 image of flag of Japan Japan 1 1.61%
6 image of flag of Indonesia Indonesia 1 1.61%

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