Injury - 2026-07-21 - Journal Article
The biomechanical performance of the both-column screw in posterior acetabular column fractures.
Öztürk V, Hürmeydan ÖM, Çelik T, Bayrak A, Kural C, Bilgili MG
Topics
Key Takeaway
Double both-column screw (dBCS) fixation achieved the lowest total deformation and fracture displacement values across all three physiological loading conditions compared to single plate, double plate, single BCS, and hybrid constructs in a finite element model of posterior acetabular column fractures.
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Summary
This FEA study compared five internal fixation constructs for posterior acetabular column fractures—sBCS, dBCS, sP, dP, and BCS+P—under level walking, stairs-up, and stairs-down loading. The single plate construct produced the highest deformation and fracture gap across all conditions, while the double BCS construct consistently yielded the lowest deformation and fracture displacement. The hybrid BCS+P construct showed variable performance, particularly in fracture gap and sliding distance metrics.
Key Limitation
FEA models a single static fracture geometry under idealized loading without accounting for bone density variation, fracture comminution, or dynamic in vivo loading, limiting direct translation to clinical fixation decisions.
Original Abstract
BACKGROUND
The both column screw (BCS) fixation technique has been described as a fixation method for acetabular posterior column fractures. This study aimed to biomechanically evaluate and compare different fixation strategies for acetabular posterior column fractures, including BCS-based, plate-based, and hybrid (BCS + P) constructs, using finite element analysis (FEA)
METHODS
Within the scope of FEA, five different internal fixation models were constructed: fixation using a single BCS (sBCS), double BCS (dBCS), a single plate (sP), double plates (dP), and a combination of one BCS and one plate (BCS+P). During the modeling process, mesh generation was performed, material properties were assigned, and boundary and contact conditions were defined. All models were subjected to three physiological loading conditions: level walking, stairs up, and stairs down. Outcomes were evaluated in terms of stress on the screw, stress on the bone, total deformation, fracture gap, and sliding distance in fracture surface.
RESULTS
Biomechanical differences were observed among the five models. The sP model demonstrated the highest deformation and fracture gap values under all loading conditions, indicating inferior biomechanical performance. In contrast, the sBCS and dP models showed lower deformation values and generally more favorable fracture stability. The BCS + P model exhibited variable performance, particularly in terms of fracture gap and sliding distance across different loading conditions. Among all configurations, the dBCS model achieved the most favorable biomechanical performance, with the lowest deformation and fracture displacement values.
CONCLUSION
The both column screw fixation technique, particularly in a double-screw configuration, provides sufficient stability for posterior column fracture fixation and may represent a viable alternative to plate-based strategies, offering an additional and stable fixation option that may expand the surgical armamentarium.