Biomechanical Study of Posterior Pelvic Fixations in Vertically Unstable Sacral Fractures: An Alternative to Triangular Osteosynthesis

Study Design Biomechanical study. Purpose To investigate the relative stiffness of a new posterior pelvic fixation for unstable vertical fractures of the sacrum. Overview of Literature The reported operative fixation techniques for vertical sacral fractures include iliosacral screw, sacral bar fixations, transiliac plating, and local plate osteosynthesis. Clinical as well as biomechanical studies have demonstrated that these conventional techniques are insufficient to stabilize the vertically unstable sacral fractures. Methods To simulate a vertically unstable fractured sacrum, 12 synthetic pelvic models were prepared. In each model, a 5-mm gap was created through the left transforaminal zone (Denis zone II). The pubic symphysis was completely separated and then stabilized using a 3.5-mm reconstruction plate. Four each of the unstable pelvic models were then fixed with two iliosacral screws, a tension band plate, or a transiliac fixation plus one iliosacral screw. The left hemipelvis of these specimens was docked to a rigid base plate and loaded on an S1 endplate by using the Zwick Roell z010 material testing machine. Then, the vertical displacement and coronal tilt of the right hemipelves and the applied force were measured. Results The transiliac fixation plus one iliosacral screw constructions could withstand a force at 5 mm of vertical displacement greater than the two iliosacral screw constructions (p=0.012) and the tension band plate constructions (p=0.003). The tension band plate constructions could withstand a force at 5° of coronal tilt less than the two iliosacral screw constructions (p=0.027) and the transiliac fixation plus one iliosacral screw constructions (p=0.049). Conclusions This study proposes the use of transiliac fixation in addition to an iliosacral screw to stabilize vertically unstable sacral fractures. Our biomechanical data demonstrated the superiority of adding transiliac fixation to withstand vertical displacement forces

ASEAN Orthopaedic Association Education Committee - Orthopaedic curriculum for residency training 2019

In November 2013, Dr Dohar Tobing, who was the President of the ASEAN Orthopaedic Association at that time, organized a Seminar on Orthopaedic Education in Yogyakarta to discuss residency training in ASEAN. At this initial meeting the training program in each country was presented by representatives from each ASEAN country. Subsequently the ASEAN Orthopaedic Association established the Education Committee under the chairmanship of Professor Lee Eng Hin to develop a common syllabus/curriculum for all ASEAN countries based on minimum standards required to practice competently as a general orthopaedic surgeon. The main objective of having a common curriculum is to facilitate exchanges of residents and fellows amongst the ASEAN countries to increase their exposure to orthopaedic conditions in the region and improve their breadth and depth of knowledge and skills. The first meeting of the Education Committee was held in Cebu in November 2014 and the Committee has since met twice a year in May and November. Training programs in the ASEAN countries were discussed and a consensus was reached on the structure and length of the training program for the AOA curriculum. In May 2016, three workgroups were formed under the leadership of Professor David Choon, Dr Dohar Tobing and Professor Lee Eng Hin to develop the detailed curriculum in the following areas: a) General Orthopaedics/Trauma/Infection/Sports/Pathophysiology/Basic Science Lead: David Choon Members: Arturo C. Canete, Jean Pierre F. Leung, Apipop Kritsaneephaiboon, Maung Mg Htwe, Sabarul A. Mokhtar b) Adult Orthopaedics/Spine/Upper Limb/Foot & Ankle/Biomaterials/Biomechanics Lead: Dohar Tobing Members: Myint Thaung, Peter Lee, Yeo Sing Jin, Kamarul Ariffin Khalid, Khin Mg Myint, Azlina Abbas c) Pediatrics/Oncology Lead: Lee Eng Hin Members: Edward HM Wang, Kanyika Chamniprasas, Pornchai Mulpruek, Istan Irmansyah Irsan, Abdul Razak Sulaiman, Wan Faisham Nu’man Wan Ismail In addition to their contributions as workgroup members, the following individuals made substantial contributions in the following areas: Pathophysiology/Basic Science: Vivek Ajit Singh and David Choon General Ortho: Wan Faisham Nu’man Wan Ismail and Kamarul Ariffin Khalid Trauma: Arturo Cañete and Jean Pierre Leung Sports Medicine: Aung Myo Win Adult-Hip & Knee: Maung Mg Htwe and Myint Thaung Spine: Dohar Tobing Upper limb/Hand: Khin Mg Myint Foot & Ankle: Inderjeet Singh Paediatrics: Lee Eng Hin and Abdul Razak Sulaiman Oncology: Edward Wang and Istan Irmansyah Irsa