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Hiyama A, Ukai T, Tanaka T, Watanabe M. Advancements in pelvic ring fracture surgery: Assessing INFIX screw placement accuracy with CT navigation. Injury 2024; 55:111600. [PMID: 38759488 DOI: 10.1016/j.injury.2024.111600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/01/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024]
Abstract
The management of unstable pelvic ring fractures, typically resulting from high-energy trauma, presents a significant clinical challenge due to the complexity of injuries. While effective in many cases, the traditional stabilization methods are fraught with various complications that can significantly impact patient recovery and quality of life (QOL). This study aims to evaluate the efficacy and precision of the anterior subcutaneous internal fixator (INFIX) technique when used with intraoperative computed tomography (CT) navigation, a novel approach intended to mitigate the limitations of conventional treatment modalities. Our retrospective case series encompasses 43 patients who sustained traumatic pelvic injuries and were subsequently treated with the INFIX technique from December 2020 to January 2024. The focus of this analysis was to assess the accuracy of INFIX screw placement facilitated by intraoperative CT navigation. A total of 81 INFIX screws were inserted, and our study findings reveal a high level of precision in screw placement, with only one screw deviating, resulting in an inaccuracy rate of merely 1.2 %. This highlights the significant advantage provided by intraoperative CT navigation. The high level of accuracy not only enhances the stability of the pelvic fixation but also substantially reduces the risk of complications commonly associated with screw misplacement, such as abdominal damage, vascular injury, and issues related to incorrect hardware positioning. In conclusion, the integration of the INFIX technique with intraoperative CT navigation in the treatment of unstable pelvic ring fractures represents a significant advancement in orthopedic trauma surgery. This study provides compelling evidence supporting the efficacy and precision of this approach, suggesting its potential as a superior alternative to traditional fixation methods. Further research, ideally through prospective studies involving larger patient cohorts, is needed to validate these findings and explore the long-term implications of this technique on patient recovery and QOL.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Taku Ukai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tatsumi Tanaka
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Zhang J, Zhang L, Li C, Chai W, Zhang L, Chen H, Zhang W, Hou Z, Chen B, Sun T, Tang P, Zhang Y. Clinical Guidelines for the Diagnosis and Treatment of Fragility Fractures of the Pelvis. Orthop Surg 2023; 15:2195-2212. [PMID: 37435891 PMCID: PMC10475682 DOI: 10.1111/os.13755] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Fragility fractures of the pelvis (FFPs) are osteoporotic pelvic fractures or insufficiency pelvic fractures caused by the low energy injury or stress fracture in daily livings in the elderly more than 60 years, which the incidence is increasing with the aging population in our country. FFPs result in considerable morbidity and mortality and as well as massive financial burden on the already strained health systems throughout the world. METHODS This clinical guideline was initiated by the Trauma Orthopedic Branch of Chinese Orthopedic Association; the External Fixation and Limb Reconstruction Branch of Chinese Orthopedic Association; the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation; Senior Department of Orthopedics of Chinese PLA general hospital; the Third Hospital of Hebei Medical University. The grading of recommendations assessment, development and evaluation (GRADE) approach and the reporting items for practice guidelines in healthcare (RIGHT) checklist were adopted. RESULTS 22 evidence based recommendations were formulated based on 22 most concerned clinical problems among orthopedic surgeons in China. CONCLUSION Understanding these trends through this guideline will facilitate better clinical care of FFP patients by medical providers and better allocation of resources by policy makers.
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Affiliation(s)
- Jianzheng Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Licheng Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Chunbao Li
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Wei Chai
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Lihai Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Hua Chen
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Wei Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Zhiyong Hou
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
- Group of Trauma Orthopaedics, Chinese Orthopaedic Association, Department of OrthopedicsThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Bin Chen
- Department of Orthopedics, Southern HospitalSouthern Medical UniversityGuangzhouChina
| | - Tiansheng Sun
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Peifu Tang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Yingze Zhang
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
- Group of Trauma Orthopaedics, Chinese Orthopaedic Association, Department of OrthopedicsThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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The role of the bilateral subcutaneous plate in the minimal invasive stabilization of fragility fractures of the pelvis. Trauma Case Rep 2022; 42:100740. [DOI: 10.1016/j.tcr.2022.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
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Tanaka K, Yoshida T, Hosoi K, Okubo N, Okada N, Takahashi K. Investigation of the risk of common femoral artery injury with anterior subcutaneous internal fixation in patients with fragility fractures of the pelvis. Injury 2022; 53:3781-3785. [PMID: 36045029 DOI: 10.1016/j.injury.2022.08.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The incidence of the fragility fractures of the pelvis (FFPs) has been increasing in recent years. Operative treatment is effective in patients who are unable to ambulate due to pain. Anterior subcutaneous internal fixation (ASIF) is a minimally invasive and stable fixation used to treat the FFPs, with few reported vascular complications. However, we experienced a case in which the rod directly pressed the common femoral artery (CFA). OBJECTIVES The purpose of this study was to examine the relationship between the rod position as defined by ASIF and the CFA in the FFPs patients, and between BMI and the rod-to-CFA distance. MATERIALS AND METHODS Pelvic measurements were performed in 47 patients with FFPs using trauma CT. We identified the anterior inferior iliac spine (AIIS) on both sides in axial CT images. Next, we performed a simulation study using the CT images, in which the virtual fixation rod was bent according to the shape of the patients' abdomen in the supine position. The shortest rod-to-CFA distance when the virtual rod was positioned directly above the AIIS in the CT image was measured. The correlation between body mass index (BMI) and the rod-to-CFA distance was measured. RESULTS The average shortest rod-to-CFA distance was 18.4 ± 11.1 mm, and the simulated rod compressed the CFA in three of the 47 cases (6.4%). A statistically significant positive correlation between BMI and the rod-to-CFA distance was found (r = 0.47, p = 0.001). CONCLUSIONS The course of the CFA should be confirmed before ASIF surgery, and if there is danger of compression of the CFA such as in patients with low BMI, the rod-to-AIIS distance should be adjusted to the optimal distance. However, considering the disadvantages, such as decreased stability of the fixation, when adjusting the rod-to-AIIS distance, and skin irritation and abrasion by the rod, ASIF is not recommended in cases in which the rod is close to the CFA.
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Affiliation(s)
- Kazuya Tanaka
- Department of Orthopaedic Surgery, Kyotango Municipal Kumihama Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Takashi Yoshida
- Department of Orthopaedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kunihiko Hosoi
- Department of Orthopaedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoki Okubo
- Department of Orthopaedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoya Okada
- Department of Orthopaedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Liu L, Fan S, Zeng D, Song H, Zeng L, Wen X, Jin D. Identification of safe channels for screws in the anterior pelvic ring fixation system. J Orthop Surg Res 2022; 17:312. [PMID: 35690864 PMCID: PMC9188702 DOI: 10.1186/s13018-022-03191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Minimally invasive surgery for pelvic fracture using anterior ring internal fixator system is increasing gradually, and the way to insert the fixation screws in the fixation system is the key technical points of the method. However, there have been few studies on insertion of fixation screws for the anterior pelvic ring internal fixator system. Objective To identify safe channels for fixation screws in the anterior pelvic fixator system and provide the anatomical basis for insertion of fixation screws in clinical operation. Methods Screw insertion was simulated into a total of 40 pelvic finite element models as well as 16 fresh pelvic specimens, and the channel parameters were measured. Results Finite elements (male, female) include: screws in ilium: length 114.4 ± 4.1 and 107.6 ± 8.3 mm, respectively; diameter 11.7 ± 0.5 and 10.0 ± 0.6 mm, distance between screw and anterior inferior iliac spine: 5.5 ± 1.0 and 5.6 ± 1.0 mm, angle of coronal plane 55.8° ± 2.4° and 50.6° ± 3.1°, angle of sagittal plane 26.6° ± 1.0° and 24.5° ± 1.9° and angle of horizontal plane 64.9 ± 3.7 and 58.1 ± 3.1; screws in pubis: length 47.0 ± 2.0 and 39.8 ± 3.9 mm, diameter 7.1 ± 0.4 and 6.1 ± 0.4 mm. Specimens (male, female) include: distance between screw and anterior inferior iliac spine: 5.5 ± 0.5 and 5.6 ± 0.7 mm, angle of coronal plane 55.9° ± 1.3° and 50.7° ± 1.5°, angle of sagittal plane 26.7° ± 0.5° and 24.1° ± 0.9° and angle of horizontal plane 64.8° ± 0.6° and 58.8° ± 0.8°. In the comparison between female and male in each group, differences in distances between screws and anterior inferior iliac spine and median line of symphysis pubis (P > 0.05) were not statistically significant; differences in the remaining parameters were statistically significant (P < 0.05). Conclusions If surgeons paid attention to sex differences, select screws of appropriate diameter and length and hold the insertion position and direction, screws in the anterior pelvic ring fixation system could be safely inserted.
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Affiliation(s)
- Lin Liu
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China.
| | - Shicai Fan
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Donggui Zeng
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Hui Song
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Letian Zeng
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xiangyuan Wen
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Dadi Jin
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Patel S, Aggarwal S, Jindal K, Kumar V, Sharma S. Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142:787-803. [PMID: 33426606 DOI: 10.1007/s00402-020-03742-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages. QUESTIONS/PURPOSES This systematic review and meta-analysis were conducted to determine the outcomes and complications of the INFIX technique for unstable pelvic ring injuries. METHODS A systematic review of literature was performed on the PubMed, EMBASE and Scopus databases. Prospective and retrospective studies in all languages, whether comparative or non-comparative, pertaining to the use of INFIX in pelvic fractures were included. Studies which did not evaluate INFIX, case reports, conference abstracts and those with less than 10 cases were excluded. Cadaveric studies, technique papers and studies that did not describe the prespecified outcome measures were also excluded. Meta-analysis consisted of two different arms: a comparative arm, to compare INFIX to symphyseal plating, and a non-comparative meta-analysis arm, to determine pooled rates of outcomes and complications. Risk of bias was determined by the Methodological Index for Non-Randomised Studies (MINORS) tool. RESULTS A total of 22 studies were included in the systematic review, of which 7 were comparative and 15 were non-comparative. 746 patients were included for qualitative analysis and pooled analysis done for 589 patients. The average follow-up of these studies ranged from a minimum of 5.4 months to a maximum of 54 months. Comparative meta-analysis (n = 3 studies) of plating and INFIX showed significantly lesser blood loss (mean difference = 176.46 mL; 95% CI - 207.54 to - 145.38) and shorter operative time (mean difference = 26.43 min, 95% CI - 31.79 to - 21.07) with INFIX, but no significant difference in the overall complication rates (OR 1.59, 95% CI 0.83-3.05) and functional outcome scores (mean difference = - 2.51, 95% CI - 5.73 to 0.71). Pooled analysis showed overall good radiological (mean percentage of excellent to good reduction = 91.4%, 95% CI 0.860-0.969) and functional outcomes (mean Majeed score = 86.48, 95% CI 83.34-89.61) with INFIX. The most common complications were lateral femoral cutaneous nerve (LFCN) injury (overall rate 28%, 95% CI 15.1-41%) and heterotopic ossification (HO) (overall rate 9.4%, 95% CI 5.5-13.3%); rates of other complications were low. Significant heterogeneity was noted in the pooled analysis of blood loss, operative time, functional outcome, HO and LFCN injury. The overall strength of evidence was found to be weak. CONCLUSION The INFIX technique can be considered as a viable alternative to symphyseal plating for unstable pelvic ring injuries. It has the advantages of shorter operative times and less blood loss, along with comparable functional outcomes, when compared to plating. Overall, good functional outcomes can be expected. However, well-designed, multi-center randomized controlled trials are needed to conclusively prove the benefit of this technique.
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Affiliation(s)
- Sandeep Patel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vishal Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddhartha Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Starr frame-assisted and minimally invasive internal fixation for pelvic fractures: Simultaneous anterior and posterior ring stability. Injury 2022; 54 Suppl 2:S15-S20. [PMID: 35177263 DOI: 10.1016/j.injury.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to investigate the surgical techniques, efficacy, and safety of Starr frame-assisted and minimally invasive internal fixation for simultaneous anterior and posterior ring stability in pelvic fractures. METHODS The clinical data of 22 patients with anterior and posterior pelvic ring injuries who underwent Starr frame-assisted and minimally invasive internal fixation were retrospectively collected. The anterior pelvic ring was fixed with an anterior subcutaneous internal fixator (INFIX), and the posterior pelvic ring was fixed with sacroiliac screws. The operative time, intraoperative blood loss, fluoroscopy times, number of assistants, complications, and weight-bearing time were analyzed. The Matta score was used to evaluate the fracture reduction. The Majeed score was used to evaluate clinical efficacy, and Gibbon's classification was used to estimate the occurrence of sacral nerve injury. RESULTS All 22 patients were treated with sacroiliac screws for posterior ring injuries, including 12 cases with single sacroiliac screws, nine with two sacroiliac screws, and one with three sacroiliac screws. INFIX was used for all anterior ring fixation, including two screws in seven cases, three screws in 13 cases, and four screws in two cases. The fracture reduction quality was excellent in 15 cases, good in four cases, and moderate in three cases by Matta scores. All patients were followed up for 6-20 (12.5 ± 5.7) months. Callus-formation time based on postoperative X-ray was 3-8 (4.3 ± 1.2) weeks. Weight-bearing time was 3-12 (6.3 ± 2.8) weeks after surgery. At the last follow-up, 15 patients were evaluated as excellent, five as good, and two as fair according to the Majeed score. Gibbons' classification showed that one of the three patients with sacral nerve injury recovered completely and two did not recover. Complications occurred in six patients, including one with internal fixation loosening, two with anterolateral thigh paresthesia, one with malunion, one with nonunion, and one with heterotopic ossification. CONCLUSIONS Starr frame-assisted and minimally invasive internal fixation could stabilize the anterior and posterior pelvic rings simultaneously, overcoming the difficulty of fracture reduction. This technique can help patients with early postoperative weight-bearing and improved functional outcomes, providing a novel modality for the minimally invasive treatment of pelvic ring injuries.
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Liu L, Fan S, Zeng D, Chen Y, Song H, Zeng L, Jin D. Clinical application of anterior ring internal fixator system combined with sacroiliac screw fixation in Tile C pelvic fracture treatment. J Orthop Surg Res 2021; 16:715. [PMID: 34906168 PMCID: PMC8670052 DOI: 10.1186/s13018-021-02863-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background How to perform minimally invasive surgery for Tile C pelvic fracture is a major problem in clinical practice. We performed minimally invasive surgery for Tile C pelvic fracture using anterior ring internal fixator systems combined with sacroiliac screw fixation.
Objective To investigate the advantages and efficacy of anterior ring internal fixator systems combined with sacroiliac screw fixation in the treatment of Tile C pelvic fracture. Methods From May 2017 to May 2020, 27 patients with Tile C pelvic fracture who underwent anterior ring internal fixator system combined with sacroiliac screw fixation (group A) and 21 patients with Tile C pelvic fracture who underwent plate-screw system combined with sacroiliac screw fixation (group B) were retrospectively analyzed. Results All 48 patients were followed up for more than 12 months, all fractures healed within 3–6 months. The operative time, intraoperative bleeding volume, blood transfusion volume, incision length, hospital stay, complication rate and Majeed score were 63.5 ± 10.7 min, 48.3 ± 27.9 ml, 0 ml, 4.5 ± 0.8 cm, 10.2 ± 2.7 d, 3.7% and 89.7 ± 4.6 points, respectively, in group A and 114.8 ± 19.1 min, 375 ± 315.8 ml, 266.7 ± 326.6 ml, 9.2 ± 3.9 cm, 20.9 ± 5.7 d, 23.8% and 88.7 ± 4.9 points, respectively, in group B. Combined excellent and good rates of the Matta evaluation and Majeed score were 100% in both groups. There were no significant differences in the Matta evaluation or Majeed score between the two groups (both P > 0.05), whereas the operative time, intraoperative bleeding volume, blood transfusion volume, incision length and hospital stay were significantly less in group A (all P < 0.05). Conclusion An anterior ring internal fixator system combined with sacroiliac screw fixation can effectively treat Tile C pelvic fracture, and has advantages, including minimal invasiveness, simple operation, short operative time, safe and reliable features, fewer complications, short hospital stay and a good curative effect.
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Affiliation(s)
- Lin Liu
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China.
| | - Shicai Fan
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Donggui Zeng
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yuhui Chen
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Hui Song
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Letian Zeng
- Orthopedic Trauma, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Dadi Jin
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Vaidya R, Amar K, Woodbury D, Washington A. Infection after the use of INFIX in Pelvic Ring Injuries. SICOT J 2021; 7:46. [PMID: 34494963 PMCID: PMC8425278 DOI: 10.1051/sicotj/2021047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The purpose of this study is to report on infection with anterior subcutaneous internal pelvic fixation (INFIX) for pelvic ring injuries and the outcomes of treatment. METHODS An IRB-approved retrospective study was performed using trauma databases of a level one and level two trauma center from 2012-2018. Infection after the INFIX procedure was diagnosed in 10 of 179 cases. Treatment included formal irrigation and debridement, removal of the hardware, and culture-specific antibiotics. Patients were followed for a minimum of 12 months. Recorded outcomes include X-rays, Majeed scores, and the presence of any loss of reduction using reduction parameters. RESULTS Time to detect the infection was 54.2 ± 24.3 days (range 24-90, median 56 days). Staphylococcus aureus was the most common bacteria isolated. The average follow-up was 830 ± 170 days (range 575-1088 days). All patients went on to the radiographic union. There were no recurrent infections or osteomyelitis at the latest follow-up. Patients maintained their reduction after INFIX removal (KI), and Majeed scores ranged from 72 to 96 (seven good, three excellent). DISCUSSION Infections after using the INFIX procedure were dealt with by irrigating and debriding the wounds, removing the INFIX with culture-specific antibiotics for 2-6 weeks. Implants were maintained for at least 25 days, and there was no loss of reduction. There were no long-term sequelae noted in this small series or the literature review included in this paper.
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Affiliation(s)
- Rahul Vaidya
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
| | - Karun Amar
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
| | - Derrek Woodbury
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
| | - Austen Washington
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
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Barrientos-Mendoza C, Brañes J, Wulf R, Kremer A, Barahona M, León S. The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures. Eur J Trauma Emerg Surg 2021; 48:3737-3746. [PMID: 34097076 DOI: 10.1007/s00068-021-01711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Management of anterior ring injuries is still a matter of discussion, and there are only few studies reporting anterior external fixator as definitive treatment for unstable pelvic injuries. This study aimed to describe the clinical and radiological outcomes of a consecutive series of mechanically unstable pelvic injuries that were treated with definitive anterior supra-acetabular external fixator for the anterior ring, and to identify risk factors for failure. METHODS We included a consecutive series of patients with unstable pelvic ring fractures who underwent anterior supra-acetabular external fixation for definitive treatment, between January 2012 and January 2020. All demographics, associated injuries and procedures, injury mechanism, and complications were analysed. Pelvic fracture was classified based on Orthopaedic Trauma Association/Tile AO (OTA/AO) and Young-Burgess classifications. Complications associated with the external fixator were revised. All patients were functionally evaluated at final follow-up and asked to report their clinical outcomes using the Majeed score. RESULTS A total of 47 patients were included, of which 25 were females. The median age was 44 years (interquartile range 23-59). Median follow-up duration was 14 months (interquartile range 6-31). The most frequent aetiology was motor vehicle accident (35), followed by fall from height (8). All fractures required posterior pelvic ring fixation. The median time during which patients had external fixation in situ was 11 weeks (interquartile range 9-13). All patients achieved healing of pelvic fracture at median time of 10 weeks (interquartile range 8-12). At final follow-up, the median displacement of the anterior pelvis was 6 mm (interquartile range 0-11). Superficial infection was the most common complication (n = 7). No washout procedures were needed. No major complication was reported. No patient required reoperation for anterior ring fracture. The median Majeed score was 88 points (range 60-95; interquartile range 80-90) at final follow-up. CONCLUSION Our findings suggest that the use of supra-acetabular external fixator is safe and effective for definitive treatment of the anterior ring in unstable pelvic fractures. It is a method with high proportion of excellent results, regardless of the type of fracture. The rate of complications is low, and it does not compromise functional results.
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Affiliation(s)
- Cristián Barrientos-Mendoza
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile. .,Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile. .,Orthopaedics Department, Hip and Pelvis Unit, Clínica Santa María, Santiago, Chile.
| | - Julián Brañes
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile.,Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | - Rodrigo Wulf
- Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | - Alex Kremer
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile
| | - Maximiliano Barahona
- Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | - Sebastián León
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile.,Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
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11
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Wu S, Chen J, Yang Y, Chen W, Luo R, Fang Y. Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases. J Orthop Surg Res 2021; 16:350. [PMID: 34059111 PMCID: PMC8165806 DOI: 10.1186/s13018-021-02387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
Background This study aimed to evaluate the radiographic and clinical outcomes of anterior subcutaneous internal fixation (INFIX) with or without posterior fixation for the treatment of unstable pelvic fractures. Methods Intraoperative blood loss, operation time, and duration of hospital stay were recorded, and fracture union and postoperative complications were evaluated. The fracture reduction quality was evaluated using the Matta score, pelvic deformity index (PDI), and pubic symphyseal width (PSW). In addition, the functional recovery and general quality of life were evaluated using the Majeed score and the 12-Item Short-Form Survey (SF-12), respectively. Furthermore, sacral nerve injury was evaluated using the Gibbons classification. Results Twenty-seven patients (14 males and 13 females) with an average age of 37.4 years were followed up for a mean of 22 months. The average operation time, median intraoperative blood loss, and average duration of hospital stay were 129 ± 47 min, 100 mL, and 22 ± 13 days, respectively. All patients achieved bony union with an average union time of 13.3 weeks. Furthermore, the average PDI and PSW were 0.07 ± 0.04 vs. 0.04 ± 0.03 (P = 0.009) and 1.15 ± 1.36 vs. 0.54 ± 0.17 (P = 0.048) before and after the operation, respectively. In 78% of the patients, the Matta or Majeed scores were excellent or good. The SF-12 physical and mental health scores were 45.1 ± 10.2 and 53.2 ± 6.3, respectively. Furthermore, one superficial surgical site infection, one loosening of INFIX, one lateral femoral cutaneous nerve irritation, one femoral nerve injury, and two implant discomforts due to the bar were noted. Among five patients with sacral nerve injuries, four were asymptomatic, and one just had paresthesia at the last follow-up. Conclusion INFIX with or without sacroiliac screws can achieve satisfactory radiographic and functional outcomes in the treatment of unstable pelvic ring fractures. Trial registration ChiCTR2000038812. Registered 04 October 2020. Retrospectively registered.
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Affiliation(s)
- Shuang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jialei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yun Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rong Luo
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yue Fang
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
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12
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Sharma S, Aggarwal S, Patel S, Kumar V, Jindal K, Sinha A. INFIX-safe and effective surgical option for complex fracture patterns of the anterior pelvic ring: A prospective single center study. J Orthop 2021; 23:142-149. [PMID: 33536724 DOI: 10.1016/j.jor.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022] Open
Abstract
Background Complex fracture patterns of anterior pelvic ring are a challenge and usually needs extensive surgeries. The purpose of this study was to evaluate INFIX as a minimally invasive procedure for such injuries in terms of feasibility, outcomes and complications in the Indian population. Methods Patients with complex fracture patterns of anterior pelvic ring were selected for anterior INFIX application along with standard posterior stabilization. Outcomes were assessed radiographically by Matta's criteria and amount of displacement. Post-operative CT scan for relation of implant to vital structures and Doppler at varying hip flexion for possible vascular occlusion was used. Functional outcomes included both disease specific scores (Majeed score, IOWA pelvic score) and quality of life scores (SMFA, SF-12). Complications were also noted. Results 12 cases out of 112 patients had complex fracture pattern of the anterior ring. Most common injury pattern were LC-3 and VS (n = 6 and 3) Young and Burgess type. The average follow up was 6 months. Fracture reduction as per Matta's criteria was excellent in 10 (83.3%) cases and good in 2 (16.6%) cases with functional outcomes excellent in 11 cases, and a mean Majeed score of 92.67 ± 5.8. The average SMFA score was 51 ± 4.39 and mean SF-12 scores for physical and mental health were 48.493 ± 6.74 and 56.370 ± 4.04 respectively. Complications noted were lateral femoral cutaneous nerve palsy (1/24 nerves), skin dehiscence (n = 2), infection (n = 2) and sacral nonunion (n = 1). Conclusion INFIX is a safe and effective minimally invasive technique for addressing complexfracture patterns involving the anterior half of pelvic ring with excellent fracture reduction, radiological and functional outcomes and predictable fracture healing.
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Affiliation(s)
- Sushank Sharma
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Sandeep Patel
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Karan Jindal
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
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13
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武 建, 师 政, 周 建, 潘 奕, 李 邵, 汪 玉. [Research progress on minimally invasive treatment of anterior pelvic ring fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:529-535. [PMID: 32291994 PMCID: PMC8171507 DOI: 10.7507/1002-1892.201907077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the related research results of minimally invasive treatment of anterior pelvic ring fracture, and to improve the understanding of minimally invasive treatment of anterior pelvic ring fracture. METHODS The literature of minimally invasive treatment of anterior pelvic ring fracture at domestic and overseas in recent years was reviewed, and the reduction and fixation methods of minimally invasive treatment were summarized and analyzed. RESULTS The pelvic reduction frame may be an effective auxiliary method for minimally invasive reduction of pelvis. The fixation methods of anterior pelvic ring include percutaneous screw fixation, stent fixation, and percutaneous plate fixation. CONCLUSION One kind of fixation is not applicable to all types of anterior pelvic ring fracture, and the fixation method should be selected according to the type of fracture and the patient's condition to minimize the complications.
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Affiliation(s)
- 建超 武
- 兰州大学第二医院骨科(兰州 730030)Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - 政伟 师
- 兰州大学第二医院骨科(兰州 730030)Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - 建伟 周
- 兰州大学第二医院骨科(兰州 730030)Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - 奕欣 潘
- 兰州大学第二医院骨科(兰州 730030)Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - 邵平 李
- 兰州大学第二医院骨科(兰州 730030)Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - 玉良 汪
- 兰州大学第二医院骨科(兰州 730030)Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
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14
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Kumbhare C, Meena S, Kamboj K, Trikha V. Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review. J Clin Orthop Trauma 2020; 11:970-975. [PMID: 33191998 PMCID: PMC7656471 DOI: 10.1016/j.jcot.2020.06.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Subcutaneous screw rod system which is popularly known as Pelvic internal fixator (INFIX) has emerged as an alternative to external fixators in management of unstable pelvic injuries. INFIX has shown various advantages over external fixation such as reduced infection rate and patient morbidity. However, it has its own set of complications such as lateral femoral cutaneous nerve injury, heterotopic ossification, femoral nerve palsy etc. We intended to conduct a systematic review of the current literature to assess outcomes and complications with INFIX technique of fixation. METHODS A comprehensive search of literature was performed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and online database of EMBASE, PubMed, Medline and Scopus was searched for all studies in English language till March 2020. Included studies were reviewed for demographic data, fracture type/classification, radiological outcome and functional outcomes. The inclusion criteria were: 1. Studies in English language 2. Clinical studies reporting use of INFIX technique in pelvis fracture where clinical and radiological outcomes were reported. RESULTS Twenty-two studies fulfilling inclusion and exclusion criteria were included in this systematic review with total of 619 patients. Radiographic parameters and outcome measures were infrequently reported. Fixation with INFIX in these fractures leads to 87% excellent to good radiological results and 84% excellent to good functional results. Complications include lateral femoral cutaneous nerve irritation (25.3%), heterotopic ossification (24.7%), infection (3%), and femoral nerve palsy (1.6%); which is likely related to placing the bar and screws too deep. CONCLUSION This analysis supports the use of INFIX in management of unstable pelvis fractures where anterior fixation is required.
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Affiliation(s)
- Chetan Kumbhare
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India
| | - Sanjay Meena
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India
| | - Kulbhushan Kamboj
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India,Corresponding author.
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Sciences and Associated JPN ApexTrauma Centre, New Delhi, India
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15
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Chen J, Walter MC, Fang Y. [Research progress in internal fixation for treatment of pelvic anterior ring injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1462-1465. [PMID: 31650767 DOI: 10.7507/1002-1892.201811105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the research progress of the application of internal fixation (INFIX) in the treatment of pelvic anterior ring injuries. Methods The recent literature about INFIX in the treatment of pelvic anterior ring injury concerning the surgery technique, biomechanical characteristics, indications, contraindications, advantages, complications, and effectiveness was extensively consulted, reviewed, and summarized. Results INFIX is a relatively novel technique for the treatment of pelvic anterior ring injuries at present. The advantages include good biomechanical properties, extensive indications, minimally invasion, convenient nursing, less complications, and excellent effectiveness. Conclusion It is a clinical method with obvious advantages and development potential for treatment of pelvic anterior ring injuries using INFIX, and further study is needed to improve its effectiveness.
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Affiliation(s)
- Jialei Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - M Chirume Walter
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yue Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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16
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Morandi MM, Daily D, Kee C, Barton RS, Solitro GF. Safe Supra-Acetabular Pin Insertion in Relation to Intraosseous Depth. J Orthop Res 2019; 37:1790-1797. [PMID: 31042305 DOI: 10.1002/jor.24323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra-acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross-sections over three-dimensional pelvic reconstructions at sagittal inclinations from 45° cranial to 45° caudal in 5° increments. Templates of screw depths spanning 60-120 mm in 15 mm increments were disposed in the transverse plane from 45° medial to 45° lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60-mm depth resulted in the largest sagittal range (60.9° ± 6.9°) and transverse range (27.5° ± 4.1°) at 30° caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20° cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20° cranial to 30° caudal with an average of 27.9° ± 1.2° (p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1790-1797, 2019.
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Affiliation(s)
- Massimo Max Morandi
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - Clarence Kee
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - R Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - Giovanni F Solitro
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
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17
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Yin Y, Luo J, Zhang R, Li S, Jiao Z, Zhang Y, Hou Z. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep 2019; 9:2578. [PMID: 30796253 PMCID: PMC6385294 DOI: 10.1038/s41598-019-39068-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to compare the clinical outcomes in patients with unstable anterior pelvic ring fractures after treatment with anterior subcutaneous internal fixator (INFIX) or plate fixation. We performed a retrospective study from August 2015 to October 2017. A consecutive series of 74 patients who underwent surgical treatment of their anterior pelvic ring (35 treated with INFIX and 39 treated with plates) were studied. Data collected included patients’ demographic data, injury severity score (ISS), AO/OTA classification, injury mechanism, time to surgery, procedure time, and blood loss. The quality of postoperative reduction were assessed by postoperative radiographs using the Tornetta and Matta method. Functional outcome was evaluated using Majeed scoring system. In the INFIX group, ten patients developed LFCN paralysis, one patient suffered from superficial infection. Three screw loosening cases and two wound infection cases occurred in the plate group. INFIX is relatively minimally invasive and time-saving than the reconstruction plate in the treatment of anterior pelvic ring fracture. However, plate fixation increases the rate of anatomic reduction of the pelvic anterior ring fracture. Plates also provide a higher functional outcome compared with INFIX. INFIX is especially suitable in patients with urological injury, which can also decrease the wound infection rate.
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Affiliation(s)
- Yingchao Yin
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Junhao Luo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Shilun Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Zhenqing Jiao
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China. .,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China. .,Chinese Academy of Engineering, Beijing, 100088, P. R. China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
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18
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Yin Y, Zhang R, Li S, Su K, Hou Z, Zhang Y. Complications Following Internal Fixator in the Treatment of Pelvic Fracture. Orthopedics 2019; 42:e7-e13. [PMID: 30403824 DOI: 10.3928/01477447-20181102-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/19/2018] [Indexed: 02/03/2023]
Abstract
The aim of this systematic review was to investigate the incidence of complications of the internal fixator in the treatment of anterior pelvic ring injury. The literature was comprehensively searched from 1980 to January 2017 to identify potential studies. Six studies involving 272 cases of anterior pelvic ring injury treated with the internal fixator were included in this meta-analysis. The rates of wound infection, heterotopic ossification, nerve paresthesia, pain, and fracture dislocation were 5.7%, 35.1%, 28.2%, 3.7%, and 3.0%, respectively. This new technique should be prudently used to treat pelvic fractures. [Orthopedics. 2019; 42(1):e7-e13.].
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19
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Abstract
INTRODUCTION The purpose of this article is to review the available literature on anterior subcutaneous internal pelvic fixation (ASIPF) to identify indications, clinical and radiographic outcomes, and compare these with alternative fixation methods. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search on PubMed and Google Scholar was performed. Articles included were in the English language or English translations and published between 2007 and 2018. Studies included were appraised with narrative data synthesis. RESULTS Twenty-five articles with 496 patients were included. These included 17 case series, with 3 case reports reporting adverse events. CONCLUSIONS ASIPF and the appropriate posterior fixation resulted in healing of pelvic ring injuries in 99.5% of cases. Indications include unstable pelvic ring injuries with the appropriate posterior fixation. Radiographic parameters and outcome measures were infrequently reported. ASIPF is a valuable tool for reduction and fixation in unstable pelvic ring injuries. Complications include lateral femoral cutaneous nerve irritation (26.3%); heterotopic ossification (36%); infection (3%); and femoral nerve palsy (1%), which is likely related to placing the bar and screws too deep.
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20
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Reichel LM, MacCormick LM, Dugarte AJ, Rizkala AR, Graves SC, Cole PA. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX. Injury 2018; 49:309-314. [PMID: 29277392 DOI: 10.1016/j.injury.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/03/2017] [Accepted: 12/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge. These methods have the purported advantages of lower wound complications, less surgical site pain, and improved quality of life. We sought to investigate the measured distances to critical anatomic structures, as well as the qualitative and topographic differences notable during implantation of both devices in the same cadaveric specimen. MATERIALS AND METHODS The Pelvic Bridge and INFIX were implanted in eleven fresh cadavers. Distances were then measured to: the superficial inguinal ring, round ligament, spermatic cord, lateral femoral cutaneous nerve (LFCN), femoral nerve, femoral artery, and femoral vein. Observations regarding implantation and topography were also recorded. RESULTS The INFIX had greater measured distances from all structures except for the LFCN, in which its proximity placed this structure at risk. Neither device appears to put other critical structures at risk in the supine position. Significant implantation and topographic differences exist between the devices. The INFIX application lacked "safety margins" concerning the LFCN in 10/11 (90.9%) specimens, while Pelvic Bridge placement lacked "safety margins" with regard to the right superficial ring (1/11, 9%) and the right spermatic cord (1/11, 9%). CONCLUSIONS Both the Pelvic Bridge and INFIX lie at safe distances from most critical pelvic structures in the supine position, though INFIX application places the LFCN at risk.
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Affiliation(s)
- Lee M Reichel
- Dell Medical School, University Of Texas, Surgery and Perioperative Care, United States
| | - Lauren M MacCormick
- University of Minnesota, Department of Orthopedic Surgery, Regions Hospital, United States
| | - Anthony J Dugarte
- University of Minnesota, Department of Orthopedic Surgery, Regions Hospital, United States
| | - Amir R Rizkala
- Stony Brook School of Medicine, Department of Physical Medicine and Rehabilitation, United States
| | - Sara C Graves
- Central Vermont Orthopaedics and Sports Medicine, University of Vermont health network, United States
| | - Peter A Cole
- University of Minnesota, Department of Orthopedic Surgery, Regions Hospital, United States.
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21
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Osterhoff G, Aichner EV, Scherer J, Simmen HP, Werner CML, Feigl GC. Anterior subcutaneous internal fixation of the pelvis - what rod-to-bone distance is anatomically optimal? Injury 2017; 48:2162-2168. [PMID: 28859843 DOI: 10.1016/j.injury.2017.08.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/03/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior fixation of the pelvis using subcutaneous supra-acetabular pedicle screw internal fixation (INFIX) has proven to be a useful tool by avoiding the downsides of external fixation in patients where open fixation is not suited. The purpose of this study was to find a rod-to-bone distance for the INFIX that allows for minimal hazard to the inguinal neuro-vascular structures and, at the same time, as little as possible interference with the soft tissues of the proximal thigh when the patient is sitting. METHODS An INFIX was applied to 10 soft-embalmed cadaver pelvises with three different rod-to-bone distances. With each configuration, the relations of the rod to the neuro-vascular and the muscular surroundings were measured in supine and sitting position. RESULTS Except for the femoral artery, vein and nerve, all investigated anatomical structures of the groin were under compression with a rod-to-bone distance of 1cm. With a rod-to-bone distance of 2cm most of the anatomical structures were safe in supine position, although less than with 3cm. With hip flexion some structures got under compression, especially the lateral femoral cutaneous nerve (LFCN, 80%) and the anterior cutaneous branches of the femoral nerve (ACBFN, 35%). With a rod-to-bone distance of 3cm almost all anatomical structures were safe in supine position, while with hip flexion most superficial structures of the proximal thigh got under compression, especially the LFCN (75%) and the ACBFN (60%). CONCLUSIONS Aiming for a rod-to-bone distance of 2cm is the safest way with regard to compression of the femoral neuro-vascular bundle and at the same time leads to the least compression of more superficial structures like the LFCN, the ACBFN, or the sartorius and the rectus femoris muscles in sitting position.
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Affiliation(s)
- Georg Osterhoff
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Elisabeth V Aichner
- Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria.
| | - Julian Scherer
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Hans-Peter Simmen
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Clément M L Werner
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Georg C Feigl
- Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria.
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22
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Tosounidis TH, Mauffrey C, Giannoudis PV. Optimization of technique for insertion of implants at the supra-acetabular corridor in pelvis and acetabular surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:29-35. [PMID: 28660437 PMCID: PMC5754460 DOI: 10.1007/s00590-017-2007-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/24/2017] [Indexed: 12/04/2022]
Abstract
The technique for application of implants at the sciatic buttress has been well described in the pelvic and acetabular fracture reconstruction literature. We described a new use of the inlet–obturator oblique view for the identification of the anterior inferior iliac spine, which is the entry point of implants, and we provide a detailed fluoroscopic and radiographic description of this view. A small series of 15 patients who underwent an application of an anterior inferior pelvic external (supra-acetabular) fixator via this technique is presented. We consider the use of the obturator oblique for the identification of the entry point unnecessary, and we advocate for the use of only the inlet–obturator oblique and iliac oblique views when implants are applied to the sciatic buttress.
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Affiliation(s)
- Theodoros H Tosounidis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK. .,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, West Yorkshire, Leeds, LS7 4SA, UK.
| | | | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK.,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, West Yorkshire, Leeds, LS7 4SA, UK
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Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries. J Orthop Trauma 2017; 31:252-259. [PMID: 28079731 PMCID: PMC5402711 DOI: 10.1097/bot.0000000000000781] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe our experience using the anterior internal pelvic fixator (INFIX) for treating pelvic ring injuries. DESIGN Case Series. SETTING Level 1 Trauma Center. PATIENTS Eighty-three patients with pelvic ring injuries were treated with INFIX. Follow-up average was 35 months (range 12-80.33). INTERVENTION Surgical treatment of pelvic ring injuries included reduction, appropriate posterior fixation, and INFIX placement. OUTCOME MEASUREMENTS Reduction using the pelvic deformity index and pubic symphysis widening, Majeed functional scores, complications; infection, implant failure, heterotopic ossification (HO), nerve injury, and pain. RESULTS All patients healed in an appropriate time frame (full weight bearing 12 weeks postoperation). The average pelvic deformity index reduction (injury = 0.0420 ± 0.0412, latest FU = 0.0254 ± 0.0243) was 39.58%. The average reduction of pubic symphysis injuries was 56.92%. The average Majeed score of patients at latest follow-up was 78.77 (range 47-100). Complications were 3 infections, 1 case of implant failure, 2 cases implantation too deep, 7 cases of lateral femoral cutaneous nerve irritation, and 3 cases of pain associated with the device. HO was seen in >50% of the patients, correlated with increased age (P < 0.007), injury severity score (P < 0.05) but only 1 case was symptomatic. CONCLUSIONS The pelvic injuries had good functional and radiological outcomes with INFIX and the appropriate posterior fixation. The downside is removal requiring a second anesthetic, there is a learning curve, HO often occurs, the lateral femoral cutaneous nerve may get irritated which often resolves once the implants are removed. Surgery-specific implants need to be developed. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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24
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Abstract
Traumatic disruptions of the pelvic ring are high energy life threatening injuries. Management represents a significant challenge, particularly in the acute setting in the presence of severe haemorrhage. Initial management is focused on preserving life by controlling haemorrhage and associated injuries. Advances in prehospital care, surgery, interventional radiology and the introduction of treatment algorithms to streamline decision making have improved patient survival. As more patients with unstable pelvic injuries survive, the poor results associated with nonoperative management and increasing patient expectations of outcome are making surgical management of these fractures increasingly common. The aim of operative fracture fixation is to correct deformity and restore function. The advent of percutaneous fixation techniques has reduced the morbidity previously associated with large operative exposures and internal fixation.
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Affiliation(s)
- James Min-Leong Wong
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
| | - Andrew Bucknill
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
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25
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Fang C, Alabdulrahman H, Pape HC. Complications after percutaneous internal fixator for anterior pelvic ring injuries. INTERNATIONAL ORTHOPAEDICS 2017; 41:1785-1790. [DOI: 10.1007/s00264-017-3415-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/23/2017] [Indexed: 01/13/2023]
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Vaidya R, Martin AJ, Roth M, Nasr K, Gheraibeh P, Tonnos F. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. INTERNATIONAL ORTHOPAEDICS 2017; 41:1671-1678. [DOI: 10.1007/s00264-016-3387-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/20/2016] [Indexed: 01/13/2023]
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Smith A, Malek IA, Lewis J, Mohanty K. Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique. J Orthop Surg (Hong Kong) 2017; 25:2309499016684994. [PMID: 28166706 DOI: 10.1177/2309499016684994] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of bilateral external iliac artery compression after application of subcutaneous anterior pelvic fixation (INFIX) technique in a 51-year-old male with an unstable pelvic fracture sustained following a motor vehicle accident. This has not been previously reported in the literature. The management of this complication is discussed in detail, along with key precautions and technical steps to consider while utilizing the 'INFIX' technique for pelvic fractures.
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Affiliation(s)
- Adam Smith
- Trauma and Orthopaedic Department, University Hospital of Wales, Heath Park, Cardiff, UK
| | - I A Malek
- Trauma and Orthopaedic Department, University Hospital of Wales, Heath Park, Cardiff, UK
| | - James Lewis
- Trauma and Orthopaedic Department, University Hospital of Wales, Heath Park, Cardiff, UK
| | - K Mohanty
- Trauma and Orthopaedic Department, University Hospital of Wales, Heath Park, Cardiff, UK
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Apivatthakakul T, Rujiwattanapong N. "Anterior subcutaneous pelvic internal fixator (INFIX), Is it safe?" A cadaveric study. Injury 2016; 47:2077-2080. [PMID: 27546721 DOI: 10.1016/j.injury.2016.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior pelvic internal fixator (INFIX) is used to treat unstable pelvic ring injuries. Nerve injury complications with this procedure have been reported. OBJECTIVES This anatomic study attempted to identify structures at risk after application of INFIX. MATERIALS AND METHODS INFIX was applied in fifteen fresh, frozen, anatomical specimens using polyaxial pedicular screws and subcutaneous rods. Surgical dissection was done to identify the structures at risk including the femoral nerve (FN), femoral artery (FA), femoral vein (FV) and the lateral femoral cutaneous nerve (LFCN) related to which are potentially affected by the implant. RESULTS All structures at risk were closer to the rod than to the pedicular screw. Measurements were made between the rod and the structures at risk. The LFCN was an average of 13.49±1.65mm (95% CI 12.871-14.103) from the lateral end of the rod. The FN was an average of 12.43±3.42mm (95% CI 11.151-13.709), the FA was an average of 12.80±3.67 (95% CI 11.430-14.173) and the FV was an average of 13.48±3.73 (95% CI 12.082-14.871) below the rod. No direct compression of the rod to the structure at risk was observed. CONCLUSIONS The femoral nerve is the structure most at risk of compression by the INFIX rod. Careful surgical technique is required in every step of this surgery. We suggest using polyaxial screws and recommend that during screw insertion the surgeon should leave some space between the screw and rectus fascia. The the rod should be trimmed as short as possible to reduce LFCN irritation.
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Affiliation(s)
- T Apivatthakakul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Thailand.
| | - N Rujiwattanapong
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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INFIX/EXFIX: Massive Open Pelvic Injuries and Review of the Literature. Case Rep Orthop 2016; 2016:9468285. [PMID: 27493818 PMCID: PMC4963555 DOI: 10.1155/2016/9468285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction. Open pelvic fractures make up 2–5% of all pelvic ring injuries. Their mortality has been reported to be as high as 50%. During Operation Enduring Freedom protocols for massive open pelvic injuries lead to the survival of injuries once thought to be fatal. The INFIX is a subcutaneous anterior fixator for pelvic stabilization which is stronger than external fixation. The purpose of this paper is to describe the use of INFIX and modern algorithms for massive open pelvic injuries. Methods. An IRB approved retrospective review describes 4 cases in civilian practice with massive open pelvic injuries. We also review the modern literature on open pelvic injures. Discussion. Key components in the care of massive open pelvic injuries include hemorrhage control by clamping of the aorta or REBOA when necessary and fecal/urinary diversion. The INFIX can be used internally, as a partial INFIX partial EXFIX, or as an EXFIX. Its low profile allows for easy application of wound vacs and wound care and when subcutaneous avoids pin tract infections. Conclusion. Massive open pelvic injuries are a difficult problem. Following modern protocols can help prevent mortality.
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Abstract
Pelvic fractures are usually the result of high-energy trauma. In addition to the underlying disruption of the pelvic ring extensive damage to the surrounding soft tissue envelope might be present. Different fixation techniques have been developed including open plating, external fixation and transramus intraosseous screw fixation. Recently another method has been reported the so called pelvic Bridge or Infix technique. In this short review article the different techniques of pelvic fixation are described.
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31
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Vigdorchik JM, Jin X, Sethi A, Herzog DT, Oliphant BW, Yang KH, Vaidya R. A biomechanical study of standard posterior pelvic ring fixation versus a posterior pedicle screw construct. Injury 2015; 46:1491-6. [PMID: 25986670 DOI: 10.1016/j.injury.2015.04.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/29/2015] [Accepted: 04/25/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to biomechanically test a percutaneous pedicle screw construct for posterior pelvic stabilisation and compare it to standard fixation modalities. METHODS Utilizing a sacral fracture and sacroiliac (SI) joint disruption model, we tested 4 constructs in single-leg stance: an S1 sacroiliac screw, S1 and S2 screws, the pedicle screw construct, and the pedicle screw construct+S1 screw. We recorded displacement at the pubic symphysis and SI joint using high-speed video. Axial stiffness was also calculated. Values were compared using a 2-way ANOVA with Bonferroni adjustment (p<0.05). RESULTS In the sacral fracture model, the stiffness was greatest for the pedicle screw+S1 construct (p<0.001). There was no significant difference between the pedicle screw construct and S1 sacroiliac screw (p=1). For the SI joint model, the S1+S2 SI screws had the largest overall load and stiffness (p<0.001). The S1 screw was significantly stronger than pedicle screw construct (p=0.001). CONCLUSIONS The pedicle screw construct biomechanically compares to currently accepted methods of fixation for sacral fractures when the fracture is uncompressible. It should not be used for SI joint disruptions as one SI or an S1+S2 are significantly stiffer and cheaper.
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Affiliation(s)
- Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Detroit Receiving Hospital, Detroit Medical Center, 4201 St. Antoine Blvd., Suite 4G, Detroit, MI 48201, United States
| | - Xin Jin
- Department of Biomedical Engineering, Wayne State University, 818 West Hancock, Detroit, MI 48201, United States
| | - Anil Sethi
- Department of Orthopedic Surgery, Detroit Receiving Hospital, Detroit Medical Center, 4201 St. Antoine Blvd., Suite 4G, Detroit, MI 48201, United States.
| | - Darren T Herzog
- Department of Orthopedic Surgery, Detroit Receiving Hospital, Detroit Medical Center, 4201 St. Antoine Blvd., Suite 4G, Detroit, MI 48201, United States
| | - Bryant W Oliphant
- Department of Orthopedic Surgery, Detroit Receiving Hospital, Detroit Medical Center, 4201 St. Antoine Blvd., Suite 4G, Detroit, MI 48201, United States
| | - King H Yang
- Department of Biomedical Engineering, Wayne State University, 818 West Hancock, Detroit, MI 48201, United States
| | - Rahul Vaidya
- Department of Orthopedic Surgery, Detroit Receiving Hospital, Detroit Medical Center, 4201 St. Antoine Blvd., Suite 4G, Detroit, MI 48201, United States
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Osterhoff G, Tiziani S, Ferguson SJ, Spreiter G, Scheyerer MJ, Spinas GL, Wanner GA, Simmen HP, Werner CML. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation. BMC Musculoskelet Disord 2014; 15:111. [PMID: 24684828 PMCID: PMC3994226 DOI: 10.1186/1471-2474-15-111] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 03/28/2014] [Indexed: 11/30/2022] Open
Abstract
Background Although useful in the emergency treatment of pelvic ring injuries, external fixation is associated with pin tract infections, the patient’s limited mobility and a restricted surgical accessibility to the lower abdomen. In this study, the mechanical stability of a subcutaneous internal anterior fixation (SIAF) system is investigated. Methods A standard external fixation and a SIAF system were tested on pairs of Polyoxymethylene testing cylinders using a universal testing machine. Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1 Hz with sinusoidal lateral compression/distraction (+/−50 N) and torque (+/− 0.5 Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700 and 900 cycles. Results There was no significant difference in translational stiffness between the SIAF and the standard external fixation when compared at 500 (p = .089), 700 (p = .081), and 900 (p = .266) cycles. Rotational stiffness observed for the SIAF was about 50 percent higher than the standard external fixation at 300 (p = .005), 500 (p = .020), and 900 (p = .005) cycles. No loosening or failure of the rod-pin/rod-screw interfaces was seen. Conclusions In comparison with the standard external fixation system, the tested device for subcutaneous internal anterior fixation (SIAF) in vitro has similar translational and superior rotational stiffness.
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Affiliation(s)
- Georg Osterhoff
- Division of Trauma Surgery, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
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Scheyerer MJ, Zimmermann SM, Osterhoff G, Tiziani S, Simmen HP, Wanner GA, ML Werner C. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes 2014; 7:133. [PMID: 24606833 PMCID: PMC3975274 DOI: 10.1186/1756-0500-7-133] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/28/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fractures of the pelvic ring including disruption of the posterior elements in high-energy trauma have both high morbidity and mortality rates. For some injury pattern part of the initial resuscitation includes either external fixation or plate fixation to close the pelvic ring and decrease blood loss. In certain situations--especially when associated with abdominal trauma and the need to perform laparotomies--both techniques may put the patient at risk of either pintract or deep plate infections. We describe an operative approach to percutaneously close and stabilize the pelvic ring using spinal implants as an internal fixator and report the results in a small series of patients treated with this technique during the resuscitation phase. FINDINGS Four patients were treated by subcutaneous placement of an internal fixator. Screw fixation was carried out by minimally invasive placement of two supra-acetabular iliac screws. Afterwards, a subcutaneous transfixation rod was inserted and attached to the screws after reduction of the pelvic ring. All patients were allowed to fully weight-bear. No losses of reduction or deep infections occurred. Fracture healing was uneventful in all cases. CONCLUSION Minimally invasive fixation is an alternative technique to stabilize the pelvic ring. The clinical results illustrate that this technique is able to achieve good results in terms of maintenance of reduction the pelvic ring. Also, abdominal surgeries no longer put the patient at risk of infected pins or plates.
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Affiliation(s)
- Max J Scheyerer
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Stefan M Zimmermann
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Georg Osterhoff
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Simon Tiziani
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Hans-Peter Simmen
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Guido A Wanner
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Clèment ML Werner
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
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Monoaxial pedicle screws are superior to polyaxial pedicle screws and the two pin external fixator for subcutaneous anterior pelvic fixation in a biomechanical analysis. Adv Orthop 2013; 2013:683120. [PMID: 24368943 PMCID: PMC3866886 DOI: 10.1155/2013/683120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022] Open
Abstract
Purpose. Comparison of monoaxial and polyaxial screws with the use of subcutaneous anterior pelvic fixation. Methods. Four different groups each having 5 constructs were tested in distraction within the elastic range. Once that was completed, 3 components were tested in torsion within the elastic range, 2 to torsional failure and 3 in distraction until failure. Results. The pedicle screw systems showed higher stiffness (4.008 ± 0.113 Nmm monoaxial, 3.638 ± 0.108 Nmm Click-x; 3.634 ± 0.147 Nmm Pangea) than the exfix system (2.882 ± 0.054 Nmm) in distraction. In failure testing, monoaxial pedicle screw system was stronger (360 N) than exfixes (160 N) and polyaxial devices which failed if distracted greater than 4 cm (157 N Click-x or 138 N Pangea). The exfix had higher peak torque and torsional stiffness than all pedicle systems. In torsion, the yield strengths were the same for all constructs. Conclusion. The infix device constructed with polyaxial or monoaxial pedicle screws is stiffer than the 2 pin external fixator in distraction testing. In extreme cases, the use of reinforcement or monoaxial systems which do not fail even at 360 N is a better option. In torsional testing, the 2 pin external fixator is stiffer than the pedicle screw systems.
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35
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Owen MT, Tinkler B, Stewart R. Failure and salvage of "INFIX" instrumentation for pelvic ring disruption in a morbidly obese patient. J Orthop Trauma 2013; 27:e243-6. [PMID: 23412505 DOI: 10.1097/bot.0b013e31828af6a4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Open-book pelvic fractures in the obese patient are accompanied by an increased risk of fixation failure. We report on the use of a recently described anterior subcutaneous pelvic internal fixator, the "INFIX" technique, in a morbidly obese patient. In this case, single and double rod constructs alone did not maintain adequate fixation due to the extreme forces in a morbidly obese patient. Successful salvage of the construct and satisfactory healing was achieved with the addition of 2 cross-links between the double rods of the INFIX.
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Affiliation(s)
- Matthew T Owen
- *Division of Orthopaedics; and †Section Trauma, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL
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36
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Sellei RM, Dienstknecht T, Brücken D, Pfeifer R, Pape HC. Percutaneous Anterior Internal Pelvic Fixator. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.oto.2013.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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