Endoscopic treatment of injuries of the anterior pelvic ring: biomechanical comparison of five different endoscopic stabilization techniques

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Injuries of the pelvic ring are severe injuries which usually need an operative stabilization of the pelvic ring. A well known surgical approach to the anterior pelvic ring is the modified Stoppa approach. This approach is associated with a relevant trauma of the soft tissue, as for a good visualization of the bony structures the abdominal wall muscles must be partially detached from the pubic rami. Approach-related complications occur with a frequency of as high as 20%. From other surgical disciplines it is known that minimally invasive approaches are able to reduce the approach related complications significantly.The most stable osteosynthesis technique of the anterior pelvic ring is the plate osteosynthesis. However, this requires an open surgical approach. Recently, we developed and presented an endoscopic approach to the symphysis (EASY) and operated the first patients with a ruptured pubic symphysis with an endoscopic plate osteosynthesis.The most widely used minimally invasive stabilization technique of the anterior pelvic ring is the external fixator, which is usually applied in the emergency setting. Other minimally invasive stabilization techniques for chronic instabilities of the pubic symphysis have been described as case reports. These techniques include dynamic stabilizations using suture anchors and they are know from arthroscopic shoulder or knee surgery, e.g. the rotator cuff repair or ACL-repair. However, there are no data available regarding biomechanical stability of these techniques in acute injuries of the pubic symphysis.Aim of this project is the comparison of five different stabilization techniques for the pubic symphysis regarding biomechanical stability. Four of them are minimally-invasive techniques and they are compared to the gold standard plate osteosynthesis. The following techniques will be tested: 1. plate osteosynthesis, 2. external fixator, 3. internal fixator, 4. suture-button-technique, 5. suture-bridge-technique. The investigations will be performed in pelvic bone models (Sawbone), validated for biomechanical testings. Beside static tests to evaluate the maximum load, especially dynamic cyclic tests are planned to simulate human walking for six weeks. The maximum dislocation of the symphysis after the respective test cycle is measured.