{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:14:04Z","timestamp":1782332044130,"version":"3.54.5"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009401","name":"Medizinischen Fakult\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen","doi-asserted-by":"publisher","award":["WiFoMed Grant Nr:80946025"],"award-info":[{"award-number":["WiFoMed Grant Nr:80946025"]}],"id":[{"id":"10.13039\/501100009401","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005722","name":"Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005722","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Open reduction and internal fixation using anterior plate osteosynthesis currently represents the gold standard for the treatment of symphyseal disruptions. Since postoperative screw loosening with consequent implant failure is frequently observed, this study aims to evaluate if and to what extent augmentation can increase the pull-out force of symphyseal screws to improve the constructs stability.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twelve human cadaveric anterior pelvic rings were separated at the symphyseal joint for bilateral testing, consequently achieving comparable sites. First, one non-augmented screw was drilled into the superior pubic ramus, whereas the contralateral side was primarily augmented. The screws were then withdrawn with a constant speed of 10\u00a0mm\/min and the fixation strengths determined by the force (N) displacement (mm) curve. Finally, the primary non-augmented site was secondary augmented, representing revision surgery after initial implant failure, and the corresponding fixation strength was measured again.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Augmentation compared to non-augmented screws displayed significantly higher pull-out forces with an increase in pull-out force by 377% for primary and 353% for secondary augmentation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). There was no significant difference in the pull-out force comparing primary and secondary augmentation (<jats:italic>p<\/jats:italic>\u2009=\u20090.74).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Primary and secondary augmentation significantly increases the stability of symphyseal screws and, therefore, potentially decreases rates of implant failure.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-022-01963-6","type":"journal-article","created":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T20:48:09Z","timestamp":1648846089000},"page":"4215-4221","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Does augmentation increase the pull-out force of symphyseal screws? A biomechanical cadaver study"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9648-0998","authenticated-orcid":false,"given":"Adrian","family":"Cavalcanti Ku\u00dfmaul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanny","family":"Schwaabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Alexander","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kleber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Linhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Thorw\u00e4chter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianka","family":"Rubenbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"B\u00f6cker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Greiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,1]]},"reference":[{"key":"1963_CR1","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1007\/s11999-012-2427-z","volume":"470","author":"SAC Morris","year":"2012","unstructured":"Morris SAC, Loveridge J, Smart DKA, et al. Is fixation failure after plate fixation of the symphysis pubis clinically important? Trauma. Clin Orthop Relat Res. 2012;470:2154\u201360. https:\/\/doi.org\/10.1007\/s11999-012-2427-z.","journal-title":"Clin Orthop Relat Res"},{"key":"1963_CR2","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1007\/s001130050585","volume":"103","author":"A Siegmeth","year":"2000","unstructured":"Siegmeth A, M\u00fcllner T, Kukla C, V\u00e9csei V. Begleitverletzungen beim schweren beckentrauma. Unfallchirurg. 2000;103:572\u201381. https:\/\/doi.org\/10.1007\/s001130050585.","journal-title":"Unfallchirurg"},{"key":"1963_CR3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","volume":"21","author":"JL Marsh","year":"2007","unstructured":"Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium\u20142007. J Orthop Trauma. 2007;21:S1\u20136. https:\/\/doi.org\/10.1097\/00005131-200711101-00001.","journal-title":"J Orthop Trauma"},{"key":"1963_CR4","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1055\/a-0648-2282","volume":"14","author":"C Spering","year":"2019","unstructured":"Spering C, Lehmann W. Therapiekonzepte bei Beckenringverletzungen. Orthop\u00e4die und Unfallchirurgie up2date. 2019;14:359\u201377. https:\/\/doi.org\/10.1055\/a-0648-2282.","journal-title":"Orthop\u00e4die und Unfallchirurgie up2date"},{"key":"1963_CR5","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00068-016-0661-x","volume":"44","author":"RJ Godinsky","year":"2018","unstructured":"Godinsky RJ, Vrabec GA, Guseila LM, et al. Biomechanical comparison of locked versus non-locked symphyseal plating of unstable pelvic ring injuries. Eur J Trauma Emerg Surg. 2018;44:179\u201384. https:\/\/doi.org\/10.1007\/s00068-016-0661-x.","journal-title":"Eur J Trauma Emerg Surg"},{"key":"1963_CR6","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1016\/j.injury.2016.05.019","volume":"47","author":"JG Eastman","year":"2016","unstructured":"Eastman JG, Krieg JC, Routt MLC. Early failure of symphysis pubis plating. Injury. 2016;47:1707\u201312. https:\/\/doi.org\/10.1016\/j.injury.2016.05.019.","journal-title":"Injury"},{"key":"1963_CR7","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1007\/s11999-012-2340-5","volume":"470","author":"C Collinge","year":"2012","unstructured":"Collinge C, Archdeacon MT, Dulaney-Cripe E, Moed BR. Radiographic changes of implant failure after plating for pubic symphysis diastasis: an underappreciated reality? Trauma. Clin Orthop Relat Res. 2012;470:2148\u201353. https:\/\/doi.org\/10.1007\/s11999-012-2340-5.","journal-title":"Clin Orthop Relat Res"},{"key":"1963_CR8","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-020-00804-8","author":"MC Jordan","year":"2020","unstructured":"Jordan MC, J\u00e4ckle V, Scheidt S, et al. Outcome after plate stabilization of symphyseal diastasis. Unfallchirurg. 2020. https:\/\/doi.org\/10.1007\/s00113-020-00804-8.","journal-title":"Unfallchirurg"},{"key":"1963_CR9","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1017\/S1481803500012732","volume":"12","author":"G Dodge","year":"2010","unstructured":"Dodge G, Brison R. Low-impact pelvic fractures in the emergency department. CJEM. 2010;12:509\u201313.","journal-title":"CJEM"},{"key":"1963_CR10","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1007\/s00113-011-2020-z","volume":"114","author":"T Fuchs","year":"2011","unstructured":"Fuchs T, Rottbeck U, Hofbauer V, et al. Beckenringfrakturen im Alter: Die untersch\u00e4tzte osteoporotische Fraktur. Unfallchirurg. 2011;114:663\u201370. https:\/\/doi.org\/10.1007\/s00113-011-2020-z.","journal-title":"Unfallchirurg"},{"key":"1963_CR11","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1007\/s00198-005-1941-1","volume":"16","author":"P Kannus","year":"2005","unstructured":"Kannus P, Palvanen M, Parkkari J, et al. Osteoporotic pelvic fractures in elderly women. Osteoporos Int. 2005;16:1304\u20135. https:\/\/doi.org\/10.1007\/s00198-005-1941-1.","journal-title":"Osteoporos Int"},{"issue":"3 SUPPL.","key":"1963_CR12","doi-asserted-by":"publisher","first-page":"309","DOI":"10.3171\/spi.2002.96.3.0309","volume":"96","author":"JS Sarzier","year":"2002","unstructured":"Sarzier JS, Evans AJ, Cahill DW. Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg. 2002;96(3 SUPPL.):309\u201312. https:\/\/doi.org\/10.3171\/spi.2002.96.3.0309.","journal-title":"J Neurosurg"},{"key":"1963_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.03.016","volume-title":"The biomechanics of pedicle screw augmentation with cement","author":"BD Elder","year":"2015","unstructured":"Elder BD, Lo SFL, Holmes C, et al. The biomechanics of pedicle screw augmentation with cement. Amsterdam: Elsevier; 2015."},{"key":"1963_CR14","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1016\/j.injury.2013.05.008","volume":"44","author":"G R\u00f6derer","year":"2013","unstructured":"R\u00f6derer G, Scola A, Schm\u00f6lz W, et al. Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures. Injury. 2013;44:1327\u201332. https:\/\/doi.org\/10.1016\/j.injury.2013.05.008.","journal-title":"Injury"},{"key":"1963_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.01.043","author":"EM Suero","year":"2020","unstructured":"Suero EM, Greiner A, Becker CA, et al. Biomechanical stability of sacroiliac screw osteosynthesis with and without cement augmentation. Injury. 2020. https:\/\/doi.org\/10.1016\/j.injury.2020.01.043.","journal-title":"Injury"},{"key":"1963_CR16","doi-asserted-by":"publisher","first-page":"S125","DOI":"10.1016\/S0020-1383(15)30031-0","volume":"46","author":"S Grechenig","year":"2015","unstructured":"Grechenig S, G\u00e4nsslen A, Gueorguiev B, et al. PMMA-augmented SI screw: a biomechanical analysis of stiffness and pull-out force in a matched paired human cadaveric model. Injury. 2015;46:S125\u20138. https:\/\/doi.org\/10.1016\/S0020-1383(15)30031-0.","journal-title":"Injury"},{"key":"1963_CR17","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1055\/s-2006-942236","volume":"144","author":"JA J\u00f6ckel","year":"2006","unstructured":"J\u00f6ckel JA, Strehl R, Gotzen L. Biomechanische untersuchungen zur fixationsfestigkeit von fadenankern aus boviner kompakta (CB-Anker) in porciner tibiakopfspongiosa im ausrei\u00dfversuch. Z Orthop Ihre Grenzgeb. 2006;144:626\u201331. https:\/\/doi.org\/10.1055\/s-2006-942236.","journal-title":"Z Orthop Ihre Grenzgeb"},{"key":"1963_CR18","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-021-01850-6","author":"F Schwaabe","year":"2021","unstructured":"Schwaabe F, Gleich J, Linhart C, et al. How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study. Eur J trauma Emerg Surg Off Publ Eur Trauma Soc. 2021. https:\/\/doi.org\/10.1007\/s00068-021-01850-6.","journal-title":"Eur J trauma Emerg Surg Off Publ Eur Trauma Soc"},{"key":"1963_CR19","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.orthres.2004.04.001","volume":"22","author":"J Seebeck","year":"2004","unstructured":"Seebeck J, Goldhahn J, St\u00e4dele H, et al. Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws. J Orthop Res. 2004;22:1237\u201342. https:\/\/doi.org\/10.1016\/j.orthres.2004.04.001.","journal-title":"J Orthop Res"},{"key":"1963_CR20","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.cmpb.2017.08.004","volume":"152","author":"KS Shih","year":"2017","unstructured":"Shih KS, Hou SM, Lin SC. Theoretical prediction of pullout strengths for dental and orthopaedic screws with conical profile and buttress threads. Comput Methods Programs Biomed. 2017;152:159\u201364. https:\/\/doi.org\/10.1016\/j.cmpb.2017.08.004.","journal-title":"Comput Methods Programs Biomed"},{"key":"1963_CR21","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s00068-016-0681-6","volume":"44","author":"MA K\u00f6nig","year":"2018","unstructured":"K\u00f6nig MA, Hediger S, Schmitt JW, et al. In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock. Eur J trauma Emerg Surg Off Publ Eur Trauma Soc. 2018;44:203\u201310. https:\/\/doi.org\/10.1007\/s00068-016-0681-6.","journal-title":"Eur J trauma Emerg Surg Off Publ Eur Trauma Soc"},{"key":"1963_CR22","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1007\/s00064-016-0449-5","volume":"28","author":"C Neuerburg","year":"2016","unstructured":"Neuerburg C, Mehaffey S, Gosch M, et al. Trochanteric fragility fractures: treatment using the cement-augmented proximal femoral nail antirotation. Oper Orthop Traumatol. 2016;28:164\u201376. https:\/\/doi.org\/10.1007\/s00064-016-0449-5.","journal-title":"Oper Orthop Traumatol"},{"key":"1963_CR23","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.spinee.2015.08.016","volume":"16","author":"L Oberkircher","year":"2016","unstructured":"Oberkircher L, Masaeli A, Bliemel C, et al. Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens-a biomechanical investigation. Spine J. 2016;16:226\u201332. https:\/\/doi.org\/10.1016\/j.spinee.2015.08.016.","journal-title":"Spine J"},{"key":"1963_CR24","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1007\/s00132-015-3134-8","volume":"44","author":"JP Kolb","year":"2015","unstructured":"Kolb JP, Weiser L, Kueny RA, et al. Cement augmentation on the spine\u202f: Biomechanical considerations. Orthopade. 2015;44:672\u201380. https:\/\/doi.org\/10.1007\/s00132-015-3134-8.","journal-title":"Orthopade"},{"key":"1963_CR25","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1097\/01.brs.0000261566.38422.40","volume":"32","author":"DJ Burval","year":"2007","unstructured":"Burval DJ, McLain RF, Milks R, Inceoglu S. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976). 2007;32:1077\u201383. https:\/\/doi.org\/10.1097\/01.brs.0000261566.38422.40.","journal-title":"Spine (Phila Pa 1976)"},{"key":"1963_CR26","doi-asserted-by":"publisher","first-page":"e351","DOI":"10.1016\/j.wneu.2020.07.154","volume":"143","author":"YS Saadeh","year":"2020","unstructured":"Saadeh YS, Swong KN, Yee TJ, et al. Effect of fenestrated pedicle screws with cement augmentation in osteoporotic patients undergoing spinal fusion. World Neurosurg. 2020;143:e351\u201361. https:\/\/doi.org\/10.1016\/j.wneu.2020.07.154.","journal-title":"World Neurosurg"},{"key":"1963_CR27","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s00064-019-0611-y","volume":"31","author":"L Weiser","year":"2019","unstructured":"Weiser L, Sehmisch S, Viezens L, Lehmann W. Intraoperative revision of initially loosened pedicle screws. Oper Orthop Traumatol. 2019;31:293\u2013300. https:\/\/doi.org\/10.1007\/s00064-019-0611-y.","journal-title":"Oper Orthop Traumatol"},{"key":"1963_CR28","first-page":"106","volume":"23","author":"A Derin\u00e7ek","year":"2012","unstructured":"Derin\u00e7ek A, T\u00fcrker M, Cinar M, et al. Revision of the failed pedicle screw in osteoporotic lumbar spine: biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation. Eklem Hastalik Cerrahisi. 2012;23:106\u201310.","journal-title":"Eklem Hastalik Cerrahisi"},{"key":"1963_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2019.09.032","author":"A Cavalcanti Ku\u00dfmaul","year":"2020","unstructured":"Cavalcanti Ku\u00dfmaul A, Greiner A, Kammerlander C, et al. Biomechanical comparison of minimally invasive treatment options for Type C unstable fractures of the pelvic ring. Orthop Traumatol Surg Res. 2020. https:\/\/doi.org\/10.1016\/j.otsr.2019.09.032.","journal-title":"Orthop Traumatol Surg Res"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-022-01963-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-022-01963-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-022-01963-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T18:13:31Z","timestamp":1664907211000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-022-01963-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,1]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["1963"],"URL":"https:\/\/doi.org\/10.1007\/s00068-022-01963-6","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,1]]},"assertion":[{"value":"10 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Adrian Cavalcanti Ku\u00dfmaul received financial support from the WiFoMed grant of the Ludwig-Maximilians-University Munich. All other authors have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. The approval of the ethics committee was obtained prior to the experiment (EA 210-16).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The relatives of the donors gave their consent prior to collection of the specimens.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All authors read and approved the final manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}