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Finite element analysis of retrograde superior ramus screw of pubis for the treament of pelvic anterior ring fracture

Journal of Orthopaedic Surgery and Research volume 20, Article number: 263 (2025) Cite this article

Abstract

Background

Retrograde superior ramus screw of pubis (SRSP) is a new kind of pelvic minimally invasive internal fixation apparatus developed by our team. The purpose of this study was to analyze the biomechanical stability of this new minimally invasive pelvic internal fixation device, and to provide this new device with theoretical basis for clinical application.

Methods

The Tile C1.3 pelvic fracture model was established. The posterior ring was fixed in the same way with two sacroiliac screws. And the anterior ring was fixed with SRSP, reconstruction plate, minimal invasive subcutaneous internal fixator (INFIX) and hollow screw respectively, to establish the finite element model of fracture-internal fixation. Finite element analysis was used to analyze the deformation and Von Mises(V-M) stress distribution of different kind of fixation under three kinds of stress conditions: vertical self-weight load, anterior-posterior(A-P) compression and lateral compression.

Results

Among the four-kind fixation models, all the maximum displacement of fracture site were significantly less than 2 cm, and the maximum V-M stress of internal fixation was lower than the yield stress of titanium metal (1050 MPa). The maximum displacement and V-M stress of total model/internal fixation in INFIX group were higher than those in the others under three stress conditions except for two cases, which were the maximum displacement of total model in SRSP group (0.26266 mm) under A-P compression and the maximum displacement of internal fixation in SRSP group (0.32588 mm) under lateral compression. The values of total model/internal fixation displacement and V-M stress distribution in SRSP group were similar to those of reconstructed plate group and hollow screw group. Furthermore, the stress distribution of SRSP group was more uniform from the stress nephogram.

Conclusion

All four kinds of internal fixation can effectively repair Tile C1.3 pelvic fractures. Also fracture-fixation pelvis model were basically restore the normal mechanical conduction path, rebuilding overall stability of the pelvic ring with good static mechanical stability. The stress distribution of fracture-internal fixation model in SRSP group was more uniform. Compared with INFIX group, SRSP group was more advantageous in preventing excessive displacement of the fracture site, loosening and deformation of the internal fixation, etc.

Introduction

The pelvis is a circular structure with complex anatomy. Compared with the posterior ring, the anterior ring of the pelvis has a weaker structure and is prone to fracture [1].The incidence of isolated pubic rami fractures after pelvic trauma is about 3-46% [2], and this type of fracture is often classified as stability injury. Fractures that included both anterior and posterior ring are more common, and about 96.8% of patients with rami pubis fractures were found to have concurrent injuries to the posterior pelvic rings [3]. In addition, 78% of the high-energy injuries have trans-pubic instability [4]. Indicating that in unstable pelvic fractures, anterior ring injury has a non-negligible proportion.

With the continuous development of surgical technology and the popularization of minimally-invasive concept in recent years, pelvic anterior ring fixation has also entered the era of minimally-invasive instead of the traditional metal plate fixation. At present, the mature treatment techniques for anterior ring fracture mainly include external fixation, screw fixation, internal stent fixation and percutaneous minimally invasive plate fixation, ect. However, most of them are unsatisfactory and scholars have never stopped exploring new internal fixation methods. To comply with the demand of the concept of minimally invasive, by using the principle of the intramedullary central fixing and combining the anatomical characteristics of the pubic symphysis, our research team designed and developed the retrograde superior ramus screw of pubis (SRSP), and has obtained the patent for utility model.

In our study, a 3D finite element model of TileC1.3 pelvic fracture model was constructed. We compared the stability of different internal fixation models and provide a theoretical basis for the new device -- SRSP.

Materials and methods

Pelvic model reconstruction

The pelvic computed tomography (CT) scan data in the Digital Imaging and Communications in Medicine (DICOM) format of a healthy adult volunteer (male, 25 years old, 175 cm height, 70 kg weight, and without previous traumatic or surgical history) were imported into Mimics21.0 (Materialise, Belgium). This study was approved by the Institutional Review Committee of our hospital with the informed consent of the patient. The 3D skeletal models including sacrum, bilateral ilium and the upper middle segment of femur were reconstructed. The STL files of bone were imported into Geomagic Wrap2021 software. The models were smoothed through remesh and local smoothing functions. Then the cancellous bone was created using integral migration function. The STP files of previous NURBS camber of skeletal models were imported into Solidworks2020 software to merge all those pelvic structures with the same origin. The articular cartilage locating at the sacroiliac joint, symphysis pubis, and hip joint were established using curve and stretching functions. Boolean operation was used to inspect there was no interference between every part. Imported into Ansys software, the pelvic model was meshed again.

Internal fixation models of anterior ring fracture

The healthy pelvic model was imported into the solidworks software, and the TileC1.3 pelvic fracture model which got left anterior pubic rami and ipsilateral sacral zone I fracture was established by cutting fracture line. Retrograde superior ramus screw of pubis, anterior ring plate, internal fixator (INFIX) and hollow screw for rami pubis (HSRP) were established in SOLIDWORKS software according to the location of the fracture line. Four different internal fixation models were established: (1) SRSP group: the anterior ring was fixed by retrograde superior ramus screw of pubis. (2) Plate group: the anterior ring was fixed by a 5-hole reconstruction plate. (3) INFIX group: the anterior ring was fixed by the minimal invasive subcutaneous internal fixator. (4) HSRP group: the anterior ring was fixed by a hollow screw of rami pubis. The posterior rings of the above models were uniformly fixed with two transsacral screws. (Fig. 1)

Fig. 1
figure 1

Four different fracture-internal fixation models: (A) SRSP group: the anterior ring was fixed by retrograde superior ramus screw of pubis. (B) Plate group: the anterior ring was fixed by a 5-hole reconstruction plate. (C) INFIX group: the anterior ring was fixed by the minimal invasive subcutaneous internal fixator. (D) HSRP group: the anterior ring was fixed by a hollow screw of rami pubis. The posterior rings of the above models were uniformly fixed with two transsacral screws

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Meshing and material parameter settings

All four fixation models were meshed in Ansys software. The statistics of the four assembly elements and the total numbers of nodes are shown in Table 1.

Table 1 The nodes and elements of 5 kinds of FE models
Full size table

It was assumed that the cortical bone, cancellous bone, plate, and screw were all continuous, isotropic, and uniform linear elastic materials. Based on previous research [5,6,7] and our experience, the elastic modulus and Poisson’s ratio of various structural materials are shown in Table 2.

Table 2 Material properties of FE models
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Boundary and loading conditions

Spring link was used to simulate the pelvic ligament reconstruction, and the parameters of the ligaments are shown in Table 3.

The following three engineering conditions were set for the four groups of fixation models. (1) Load in vertical direction (engineering condition 1): To mimic the standing position, the lower cross section of the femur on both sides were fixed and the pelvis was restricted in 6 directions of freedom. A vertical downward load of 500 N was imposed on the upper surface of the S1 vertebra to simulate the gravity of the upper part of the body. (2) Anterior-posterior(A-P) compression (engineering condition 2): Back of bilateral iliac spines were fixed and 250 N horizontal loads from forward to backward were applied to each side of the anterior superior iliac spine to simulate the effect of anterior-posterior compression. (3) Load in horizontal lateral direction (engineering condition 3): Bilateral acetabular fossas were fixed and a 500 N horizontal lateral load was imposed to the left iliac tubercle to simulate the effect of lateral compression.

Furthermore, a sensitivity analysis was systematically conducted to evaluate the accuracy and efficiency of FE models by adjusting the optimal element size. Element sizes of 1 mm, 2 mm, and 3 mm for the bone were examined. The maximum von Mises stress on bone was set to be tested and the used convergence criterion was a change of < 5% [8], which was considered to be mesh convergence. After the convergence measurement, the mesh size was determined to be 2 mm.

Table 3 Different parameters of pelvic ligaments
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Evaluation criteria

Following data of total pelvic model and internal fixation were measured which comprised (1) the maximum displacements (2) the stress distribution and Von Mises (V-M) peak stress (3) displacements on both sides of the pubic fracture line (4) absolute value of separation in the horizontal direction of the fracture surfaces.

Results

It can be seen that the stress of the pelvic ring is transmitted from the top to bottom and the middle to sides, with a maximum stress of 39.431 MPa. The displacement (deformation) of the pelvis is roughly symmetrical from left to right and weakened in a wavy pattern along the iliac crest, with a maximum displacement of 0.08923 mm. The overall displacement of the pelvic model and the stress cloud map are essentially similar to that of the description in the relevant literature [9, 10], which also shows the validity of the pelvic finite element model. (Fig. 2)

Fig. 2
figure 2

The view of healthy pelvis model with the action of standing position: (A) Front view of V-M stress nephogram. (B) Front view of displacement nephogram. (C) Back view of V-M stress nephogram. (D) Back view of displacement nephogram

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Engineering condition 1

When simulating the vertical force of self-weight, it can be seen that the maximum displacement of overall model in each group, of which the highest value is 0.23161 mm (Fig. 5A), located in model INFIX. And the lowest is 0.045158 mm (Fig. 3A), located in model SRSP (Fig. 4). Among the maximum displacement of internal fixation in each group, the highest is 0.07138 mm (Fig. 5C) located in model INFIX. The lowest is 0.026625 mm (Fig. 3C), located in model SRSP. The maximum space of pubic bone broken ends is 36.8032 × 10− 3mm in model INFIX and the minimum space is 1.5289 × 10− 3mm in model HSRP (Table 4).

Fig. 3
figure 3

The view of model 1 under vertical self-weight load: (A) Displacement distribution of total model. (B) V-M stress distribution of total model. (C) Displacement distribution of internal fixation. (D) V-M stress distribution of internal fixation

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Fig. 4
figure 4

The view of model 2 under vertical self-weight load: (A) Displacement distribution of total model. (B) V-M stress distribution of total model. (C) Displacement distribution of internal fixation. (D) V-M stress distribution of internal fixation

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Fig. 5
figure 5

The view of model 3 under vertical self-weight load: (A) Displacement distribution of total model. (B) V-M stress distribution of total model. (C) Displacement distribution of internal fixation. (D) V-M stress distribution of internal fixation

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Among the maximum V-M stress value of overall model in each group, of which the highest is 526.77 MPa (Fig. 5B) located in model INFIX. And the minimum is 22.419 MPa (Fig. 6B), located in model HSRP. Among the maximum V-M stress value of internal fixation, the highest is 185.63 MPa (Fig. 5D) located in model INFIX. The minimum is 12.685 MPa (Fig. 3D), located in model SRSP. According to the comparison of stress cloud figure in engineering condition 1, the stress distribution of SRSP is more uniform than others groups.

Fig. 6
figure 6

The view of model 4 under vertical self-weight load: (A) Displacement distribution of total model. (B) V-M stress distribution of total model. (C) Displacement distribution of internal fixation. (D) V-M stress distribution of internal fixation

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Combining all groups of data (Table 5), who has the better biomechanical effect are model SRSP and model HSRP, while the worse one is model INFIX (Fig. 7).

Fig. 7
figure 7

The comparison of maximum stress and maximum displacement of four models under different working conditions: (A) The maximum displacement of overall finite element model. (B) The maximum stress of overall finite element model. (C) The maximum displacement of internal fixation. (D) The maximum stress of internal fixation

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Table 4 Displacement of anterior pelvic ring fracture
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Engineering condition 2

When simulating to face the A-P compression, it can be seen that the maximum displacement of overall model in each group, of which the highest value is 0.26266 mm, located in model SRSP. And the lowest is 0.23279 mm, located in model HSRP. Among the maximum displacement of internal fixation in each group, the highest is 0.18505 mm located in model INFIX. The lowest is 0.14732 mm, located in model HSRP. The maximum space of pubic bone broken ends is 6.4647 × 10− 3mm in model INFIX and the minimum space is 0.7488 × 10− 3mm in model (Table 4).

Among the maximum V-M stress value of overall model in each group, of which the highest is 44.334 MPa located in model INFIX. And the lowest is 29.668 MPa, located in model Plate. Among the maximum V-M stress value of internal fixation, the highest is 44.334 MPa located in model INFIX. The lowest is 18.316 MPa, located in model HSRP. According to the comparison of stress cloud figure in engineering condition 2, the stress distribution of HSRP is more uniform than others groups. (See Supplementary Figs. 1–4, Additional File 1)

Combining all groups of data(Table 5), who has the better biomechanical effect are model SRSP and model HSRP (Fig. 7).

Engineering condition 3

When simulating the force in horizontal lateral direction, it can be seen that the maximum displacement of overall model in each group, of which the highest value is 1.055 mm, located in model INFIX. And the lowest is 0.88487 mm, located in model HSRP. Among the maximum displacement of internal fixation in each group, the highest is 0.32588 mm located in model SRSP. The lowest is 0.17156 mm, located in model Plate. The maximum space of the pubic bone broken ends is 30.334 × 10− 3mm in model INFIX and the minimum space is 0.271 × 10− 3mm in model HSRP (Table 4).

Table 5 Data of four groups of models in different conditions
Full size table

Among the maximum V-M stress value of overall model in each group, of which the highest is 533.62 MPa located in model INFIX. And the lowest value is 79.129 MPa, located in model SRSP. Among the maximum V-M stress value of internal fixation, the highest is 247.68 MPa located in model INFIX. The lowest is 79.129 MPa, located in model SRSP. According to the comparison of stress cloud images in engineering condition 3, the stress distribution of SRSP is more uniform than others groups. (See Supplementary Figs. 5–8, Additional File 1).

Combining all groups of data (Table 4), who has the better biomechanical effect are model HSRP and model SRSP (Fig. 7).

Discussion

The pelvis is a complete ring composed of sacrum and iliums on both sides connected by strong ligaments and fibrocartilage, which plays an important role in transmitting the upper and lower stress of the axial bones. It was widely believed that injury to the posterior pelvic ring would cause significant instability of the overall pelvic ring. There is no consensus on whether simultaneous fixing anterior and posterior rings is as important to provide adequate stability to the pelvic ring as doing posterior rings alone [11, 12]. However, with the development of the research on anterior ring in recent years, researchers have found that the stability of anterior ring may influence the stress of posterior ring or the deformation of broken ends [13]. More attention has been paid to the reconstruction of the stability of anterior pelvic ring [14]. For the instability of the ring, restoring anatomical structure and solid fixation are the prerequisites for early functional rehabilitation, in order to meet the demands of more and more patients for a better prognosis.

It is known from the literature that the incidence of simple isolated pubic branch fractures is relatively low. Scheyerer et al. [3]’s study showed that about 96.8% of patients with pubic branch fractures were found to be accompanied with injuries to the posterior pelvic ring. Therefore, our study chose to establish the finite element model of C1.3 fracture, which is a representative of unstable pelvic fractures. In our study, percutaneous sacroiliac screws were used to fix the posterior pelvic ring, which is a reliable and minimally invasive central fixation method, providing sufficient stability and effectively resist vertical shear and torsion forces [[15], [16]]. In this study, two sacroiliac screws were used to fix the posterior ring in all fracture models, which not only conformed to the concept of minimally invasive treatment, but also reduced the calculation error that may be caused by the unstable fixation of the posterior ring.

It is generally considered that the growth of callus is greatly affected by movement between the broken ends of fracture clinically. And it is difficult to heal when the distance between ends is more than 2 cm, which usually means the failure of internal fixation [17]. The controlled micromovements between the fracture ends can promote callus formation and fracture healing, which are important mechanical parameters in the healing process [18, 19]. Long-term follow-up by some scholars has shown that the fracture healing prognosis is better when the displacement of the broken ends of pelvic posterior ring is between 0.2 and 1 mm. Movements exceeding this range may have a negative effect on fracture healing [20,21,22,23]. In our study four groups of the maximum displacement of overall finite element model and movement of broken ends of pubis in three engineering conditions were all less than 1 mm. Under the vertical force of self-weight, the maximum displacement of overall finite element model are compared as: INFIX model > Plate model > HSRP model > SRSP model. The movement of broken ends of pubis are compared as: INFIX model > Plate model > SRSP model > HSRP model. Under the force in horizontal from forward to backward direction, the maximum displacement of overall model are compared as: SRSP model > INFIX model > Plate model > HSRP model. The movement of broken ends of pubis are compared as: INFIX model > Plate model > HSRP model > SRSP model. Under the force in horizontal lateral direction, the maximum displacement of overall model are compared as: INFIX model > SRSP model > Plate model > HSRP model. The movement of broken ends of pubis are compared as: INFIX model > Plate model > SRSP model > HSRP. Smaller displacement strain in each part of pelvis represents better biomechanical stability. In summary, it can be seen that four internal fixation schemes can effectively fix TileC1.3 pelvic fractures and provide stability. And also there was no obvious stress concentration in the four internal fixation models. Comparison between groups shows the SRSP and HSRP are superior to others.

In general, the risk of endoplant failure arises from stress load and travel distance. When there is no obvious stress concentration, the lower the maximum stress of internal fixation, the less the risk of breaking. The smaller the movement distance of internal fixation, the less the risk of loosening. Under the vertical force of self-weight, the maximum displacement of internal fixation are compared as: INFIX model > Plate model > HSRP model > SRSP model. The maximum stress of internal fixation are compared as: INFIX model > Plate model > HSRP model > SRSP model. Under the force in horizontal from forward to backward direction, the maximum displacement of internal fixation are compared as: INFIX model > SRSP model > Plate model > HSRP model. The maximum stress of internal fixation are compared as: INFIX model > SRSP model > Plate model > HSRP model. Under the force in horizontal lateral direction, the maximum displacement of internal fixation are compared as: SRSP model > INFIX model > HSRP model > Plate model. The maximum stress of internal fixation are compared as: INFIX model > HSRP model > Plate model > SRSP model. And we could discover from the stress cloud image that and the stress distribution of SRSP and HSRP were more uniform than others.

In the above engineering conditions, the maximum stress subjected to internal fixation is lower than the yield stress of titanium metal (1050Mpa), thus basically no fracture will occur [24]. In comparison, the SRSP is more advantageous in the field of less loosening.

In this study, no obvious fracture end separation, fracture or obvious deformation, or loosening of the inner plant were found in each model. And the displacement and stress changes showed similar distribution rules to the normal model, indicating that all four anterior internal fixation schemes have effectively fixed and restored the load-bearing function for TileC1.3 pelvic fractures. In addition, the data of the reconstructed plate fixation group were satisfactory in various engineering conditions, which also verified that plate internal fixation is the potential treatment standard.

Suprapubic branch hollow screw fixation is currently a commonly used method for minimally invasive treatment of pelvic fractures. However, due to the arcuated anatomy of the pubic branch, it is difficult to place nails because of the narrow bone channel in some patients, requiring multiple X-ray during operation. For some patients, the screw placement may can’t be done. And nails removement may happen to middle-aged and elderly female patients with osteoporosis [25]. The SRSP was independently designed by our team based on anatomical data of the normal pelvic structure in the Chinese population (Chinese Patent No.: ZL 2020 2 1969847.8). It features a curved configuration with an approximately 15° arc, incorporating a bullet-shaped tip and an expanded cylindrical tail. (See Supplementary Figs. 9–11, Additional File 1). In contrast to the hollow screws, the arc-shaped structure of SRSP is more in line with the anatomical structure of the anterior pelvic ring. The solid bullet-shaped tip simultaneously, provides self-drilling and guidance capabilities during clinical implantation. This design facilitates reduced insertion resistance and enhanced procedural efficiency compared to traditional hollow screw systems. Combined with the uniform stress distribution and good overall control, SRSP fixation scheme can be used as a new choice for the treatment of pelvic ring injury.

This study also has limitations that should be considered. One limitation of this study is that only sketetal and ligament systems of the pelvis was employed to develop finite element models, excluding the effect muscles. Although this is a common approach in similar finite element analyses, the muscle forces which were neglected may make the stress on the broken ends more complicated. Additionally, the bone was set as an isotropic material, while bone is in fact an anisotropic material. While our fracture models cannot cover all possible real-life situations, they still offer valuable insights. Given these limitations, our conclusions would benefit from further confirmation through clinical retrospective studies and cadaveric biomechanical experiments.

Conclusion

In our study, we explored the biomechanical outcome of the new device for treating pubis rami fracture by finite element analysis. Based on the established 3D finite element model of the pelvis, four internal fixation models for TileC1.3 fractures were built and compared by biomechanical finite element analysis. With sufficient biomechanical stability, the new device SRSP can be used as a reliable fixation for the treatment of pelvic anterior ring fracture. The study provides a good theoretical basis for subsequent clinical investigations of the various therapeutic procedures in the future.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

SRSP:

Retrograde superior ramus screw of pubis

INFIX:

Minimal invasive subcutaneous internal fixator

DICOM:

Digital Imaging and communications in medicine

V-M:

Von Mises Stress

HSRP:

Hollow screw of rami pubis

A-P:

Anterior-posterior

STL:

Stereo Lithography

STP:

Exchange Structure of 3D Picture Files

FE:

Finite element

References

  1. Vaidya R, Martin A J, Roth M, et al. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. Int Orthop. 2017;41(8):1671–8.

    Article  PubMed  Google Scholar 

  2. Fensky F, Weiser L, Sellenschloh K, et al. Biomechanical analysis of anterior pelvic ring fractures with intact peripelvic soft tissues: a cadaveric study. Eur J Trauma Emerg Surg. 2021;47(1):187–93.

    Article  PubMed  Google Scholar 

  3. Scheyerer MJ, Osterhoff G. Detection of posterior pelvic injuries in fractures of the pubic Rami. Injury. 2012;43(8):1326–9.

    Article  PubMed  Google Scholar 

  4. Gänsslen A, Pohlemann T. Epidemiology of pelvic ring injuries [J]. Injury. 1996;27(Suppl 1):S–a13.

    Article  PubMed  Google Scholar 

  5. Anderson A E, Peters C L, Tuttle B D, et al. Subject-specific finite element model of the pelvis: development, validation and sensitivity studies. J Biomech Eng. 2005;127(3):364–73.

    Article  PubMed  Google Scholar 

  6. Dalstra M, Huiskes R, Van Erningl. Development and validation of a three-dimensional finite element model of the pelvic bone. J Biomech Eng. 1995;117(3):272–8.

    Article  PubMed  CAS  Google Scholar 

  7. Kim YH, Yao Z, Kim K, et al. Quantitative investigation of ligament strains during physical tests for sacroiliac joint pain using finite element analysis [J]. Man Ther. 2014;19(3):235–41.

    Article  PubMed  Google Scholar 

  8. Zhang J, Wei Y, Wang J. er al. Numerical study of pedicle screw construction and locking compression plate fixation in posterior pelvic ring injuries: Analyzed by finite element method [J]. Medicine (Baltimore). 2024;103(20):e38258.

  9. Shi D, Wang F, Wang D, et al. 3-D finite element analysis of the influence of synovial condition in sacroiliac joint on the load transmission in human pelvic system [J]. Med Eng Phys. 2014;36(6):745–53.

    Article  PubMed  Google Scholar 

  10. Hammer N, Steinke H, Lingslebe U, et al. Ligamentous influence in pelvic load distribution [J]. Spine J. 2013;13(10):1321–30.

    Article  PubMed  Google Scholar 

  11. Parry JA, Funk A, Heare A, et al. An international survey of pelvic trauma surgeons on the management of pelvic ring injuries [J]. Injury. 2021;52(10):2685–92.

    Article  PubMed  Google Scholar 

  12. Marecek G S, Scolaro JA. Anterior pelvic ring: introduction to evaluation and management [J]. J Orthop Trauma. 2018;32(Suppl 6):S1–3.

    Article  PubMed  Google Scholar 

  13. Ellis JD, Shah N S, Archdeacon M T, et al. Anterior pelvic ring fracture pattern predicts subsequent displacement in lateral compression sacral fractures [J]. J Orthop Trauma. 2022;36(11):550–6.

    Article  PubMed  Google Scholar 

  14. Collinge, C, Archdeacon M T, Dulaney-Cripe E, et al. Radiographic changes of implant failure after plating for pubic symphysis diastasis: an underappreciated reality? [J]. Clin Orthop Relat Res. 2012;470(8):2148–53.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wu T, Chen W, Zhang Q, et al. Biomechanical comparison of two kinds of internal fixation in a type C zone II pelvic fracture model [J]. Chin Med J (Engl). 2015;128(17):2312–7.

    Article  PubMed  Google Scholar 

  16. Kim JJ, Jung C Y, Eastman J G, et al. Measurement of optimal insertion angle for iliosacral screw fixation using Three-Dimensional computed tomography scans [J]. Clin Orthop Surg. 2016;8(2):133–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jordan R W, Smith N A Dickensone, et al. Risk factors associated with the early failure of cannulated hip screws [J]. Acta Orthop Belg. 2014;80(1):34–8.

    PubMed  Google Scholar 

  18. Claes L. The mechanical and morphological properties of bone beneath internal fixation plates of differing rigidity [J]. J Orthop Research: Official Publication Orthop Res Soc. 1989;7(2):170–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/jor.1100070203.

  19. Woo SL, Lothringer K S, Akeson W H, et al. Less rigid internal fixation plates: historical perspectives and new Concepts[J]. J Orthop Research: Official Publication Orthop Res Soc. 1984;1(4):431–49.

    Article  CAS  Google Scholar 

  20. Claes L, Augat P, Suger G, et al. Influence of size and stability of the osteotomy gap on the success of fracture healing [J]. J Orthop Research: Official Publication Orthop Res Soc. 1997;15(4):577–84.

    Article  CAS  Google Scholar 

  21. Goodship A E Kenwrightj. The influence of induced micromovement upon the healing of experimental tibial fractures [J]. J Bone Joint Surg Br. 1985;67(4):650–5.

    Article  PubMed  Google Scholar 

  22. Claes L. Biomechanical principles and mechanobiologic aspects of flexible and locked plating [J]. J Orthop Trauma. 2011;25(S1):S4–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/BOT.0b013e318207093e.

  23. Yang J, Boker K O, Li X, et al. Unilateral Lumbo-Pelvic fixation for Denis type I unilateral sacral fracture: A finite element analysis [J]. JOR Spine. 2025;8(1):e70022.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Hu P, Wu T, Wang H Z, et al. Biomechanical comparison of three internal fixation techniques for stabilizing posterior pelvic ring disruption: A 3D finite element analysis [J]. Orthop Surg. 2019;11(2):195–203.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cole P A, Dyskin E A, GILBERTSON JA. Minimally-invasive fixation for anterior pelvic ring disruptions [J]. Injury. 2015;46(Suppl 3):S27–34.

    PubMed  Google Scholar 

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Acknowledgements

We would like to thank all the team members for cooperation.

Funding

This work was supported by the National Key Research and Development Program of China (2022YFC2504303); Innovation Foundation of National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation (2021-NCRC-CXJJ-ZH-24); Medical Innovation and Transformation Incubation Project of Tongji Hospital (2022ZHFY10). The funding organization had no role in the design and conduct of the study.

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Authors and Affiliations

  1. Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China

    Gu Meiqi, Xu Zhe, Li Yifei, Xiang Penghui, Wang Zhen, Zhang Rui, Xin Fei, Tang Zhaohui & Yi Chengla

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  1. Gu Meiqi
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Contributions

GM conceived and designed the study, and wrote the main manuscript. XZ, XP and ZR prepared the imaging data. WZ, XF and LY provided related guidance. YC and TZ revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yi Chengla.

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13018_2025_5676_MOESM1_ESM.pptx

Supplementary Material 1: Additional file: The file is PPT. The data in additional file are the results of the infite element analysis and more details about the design of SRSP. Considering the restriction of the space on printed page, we put more figures in additonal file.

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Meiqi, G., Zhe, X., Yifei, L. et al. Finite element analysis of retrograde superior ramus screw of pubis for the treament of pelvic anterior ring fracture. J Orthop Surg Res 20, 263 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13018-025-05676-5

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13018-025-05676-5

Keywords

Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X