The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes

Management of floating hip injury: a review of the literature

Aim

The aim of this study was to provide a comprehensive overview of floating hip injury and attempt to provide a management algorithm.

Methods

PubMed was searched using the terms 'Floating hip' or 'acetabular fracture' and 'Ipsilateral femoral fracture' or 'pelvic fracture' and 'Ipsilateral femoral fracture'. One author performed a preliminary review of the abstracts and references of the retrieved articles.

Results

The mean injury severe score reported was higher than 20. Chest and abdominal injuries, as well as fractures at other sites, were the most common associated injuries. Despite the high disability rate, surgery remained the preferred option for managing these injuries. The surgical timing varied from a few hours to several days and was subjected to the principles of damage control orthopedics. Although, in most cases, fixation of femoral fractures took precedence over pelvic or acetabular fractures, there was still a need to consider the impact of damage control orthopedics, associated injuries, and surgeon's considerations and preferences. Posttraumatic arthritis, neurological deficits, heterotopic ossification, femoral head necrosis, femoral nonunion, and limb inequality were common complications of the floating hip injury.

Conclusions

The severity of such injuries often exceeds that of an isolated injury and often requires specialized multidisciplinary treatment. In the management of these complex cases, the complexity and severity of the injury should be fully assessed, and an appropriate surgical plan should be developed to perform definitive surgery as early as possible, with attention to prevention of complications during the perioperative period.

Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies

PURPOSE

Pelvic ring fractures requiring surgical stabilization are severe injuries. Surgical site infections occurring after stabilization of the pelvis are serious complications, requiring complex and multidisciplinary treatment.

METHODS

This is a retrospective observational study from a level I trauma centre. One hundred and ninety-two patients who underwent stabilization of closed pelvic ring injuries without signs of pathological fracture were selected for inclusion into the study. After excluding seven patients for having incomplete data, the final study group consisted of 185 patients (117 men and 68 women). Basic epidemiologic data and potential risk factors were recorded and analyzed by Cox regression, Kaplan-Meier curves, and risk ratios in 2 × 2 tables. Categorical variables were compared by Fisher exact tests and chi squared tests. Parametric variables were analyzed with Kruskal-Wallis tests with post hoc Wilcoxon tests.

RESULTS

Surgical site infections occurred in 13% of the study group (24 from 185). Eighteen infections occurred in men (15.4%) and six in women (8.8%). There were two significant risk factors in women: age over 50 years (p = 0.0232) and concomitant urogenital trauma (p = 0.0104). The common risk ratio for both these factors was 212.59 (8.78-5148.68), p = 0.0010. No significant risk factors were identified in men despite younger men having a higher incidence of infection (p = 0.1428).

CONCLUSION

Overall rate of infectious complications was higher than in the literature, but this might be caused by inclusion of all patients regardless of surgical strategy. Higher age in women and lower age in men were associated with higher infection rates. Concomitant urogenital trauma was a significant risk factor in women.

Medium-term clinical results in patients with floating hip injuries

BACKGROUND

The objective of this study was to evaluate the effectiveness of our strategy for managing floating hip injuries.

METHODS

From January 2014 and December 2019, all patients with a floating hip underwent surgical treatment in our hospital were included in the retrospective study, with a minimum follow-up of 1 year. All patients were managed according to a standardised strategy. Data on epidemiology, radiography, clinical outcomes and complications were collected and analysed.

RESULTS

Twenty-eight patients were enrolled, with an average age of 45 years. The mean follow-up was 36.9 months. According to the Liebergall classification, Type A floating hip injuries predominated (n = 15, 53.6%). Head and chest injuries were the most common associated injuries. When multiple operative settings were required, we prioritized the fixation of the femur fracture at the first operation. The mean time from injury to definitive femoral surgery was 6.1 days, with most (75%) femoral fractures treated with intramedullary fixation. More than half (54%) of acetabular fractures were treated with a single surgical approach. Pelvic ring fixation included isolated anterior fixation, isolated posterior fixation, combined anterior and posterior fixation, of which isolated anterior fixation was the most common. Postoperative radiographs suggested that the anatomic reduction rates of acetabulum and pelvic ring fractures were 54% and 70%, respectively. According to grading system of Merle d'Aubigne and Postel, 62% of patients achieved satisfactory hip function. Complications included delayed incision healing (7.1%), deep vein thrombosis (10.7%), heterotopic ossification (10.7%), femoral head avascular necrosis (7.1%), post-traumatic osteoarthritis (14.3%), fracture malunion (n = 2, 7.1%) and nonunion (n = 2, 7.1%). In the patients with complications described above, only two patients underwent resurgery.

CONCLUSIONS

Although there is no difference in clinical outcomes and complications among different types of floating hip injuries, special attention should be paid to anatomical reduction of the acetabular surface and restoration of the pelvic ring. In addition, the severity of such compound injuries often exceeds that of an isolated injury and often requires specialised multidisciplinary management. Because of no standard guidelines for treatment of such injuries, our experience in the management of such a complex case is to fully assess the complexity of the injury and formulate an appropriate surgical plan based on the principles of damage control orthopaedics.

Biomechanical study of anterior and posterior pelvic rings using pedicle screw fixation for Tile C1 pelvic fractures: Finite element analysis

Objective

The purpose of this study was to analyse the biomechanical characteristics of pedicle screws with different placement methods and diameters in the treatment of Tile C1 pelvic fractures by finite element simulation technology and to compare them with the plate fixation model to verify the effectiveness of pedicle screw fixation.

Methods

A three-dimensional digital model of a normal pelvis was obtained using computed tomography images. A finite element model of a normal pelvis containing major ligaments was built and validated (Model 1). Based on the verified normal pelvis finite element model, a Tile C1 pelvic fracture model was established (Model 2), and then a plate fixation model (Model 3) and a pedicle screw fixation model with different screw placement methods and diameters were established (Models 4–15). For all pelvic fracture fixation models, a vertical load of 500 N was applied on the upper surface of the sacrum to test the displacement and stress distribution of the pelvis in the standing state with both legs.

Results

The finite element simulation results showed the maximum displacement of Model 1 and Models 3–15 to be less than 1 mm. The overall maximum displacement of Models 4–15 was slightly larger than that of Model 3 (the maximum difference was 177.91×10⁻³ mm), but the maximum displacement of iliac bone and internal fixation in Models 4–15 was smaller than that of Model 3. The overall maximum stress (maximum stress of the ilium) and maximum stress of internal fixation in Models 4–15 were less than those in Model 3. The maximum displacement difference and maximum stress difference at the fracture of the pubic ramus between each fixed model were less than 0.01 mm and 1 MPa, respectively. The greater the diameter and number of pedicle screws were, the smaller the maximum displacement and stress of the pelvic fracture models were.The maximum displacement and stress of the pelvic fracture models of the screws placed on the injured side of the pubic region were smaller than the screws on the healthy side.

Conclusion

Both the anterior and posterior pelvic rings are fixed with a pedicle screw rod system for treatment of Tile C1 pelvic fractures, which can obtain sufficient biomechanical stability and can be used as a suitable alternative to other implants.The greater the diameter and number of pedicle screws were, the greater the pelvic stability was, and the greater was the stability of the screws placed on the injured side of the pubic region than the screws on the healthy side.

Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis

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.

Posterior INFIX for Treating Unilateral Unstable Sacral Fractures

Objective

To evaluate the clinical outcomes of the treatment of unilateral unstable sacral fractures by fixation with the posterior INFIX (posterior pelvic ring screw‐rod internal fxation).

Methods

Data of 60 patients with unilateral unstable sacral fractures who underwent surgery from March 2013 to March 2020 were retrospectively analyzed according to the selection criteria. All patients were associated with anterior pelvic ring injuries, and the operations were performed by the same team of surgeons. According to the different types of internal fixation, the patients were divided into two groups, which both included 30 patients: the posterior INFIX group and iliosacral screw fixation group. The demographic and clinical data of the two patient groups, such as age, sex, sacral fracture types based on the Denis classification, operation time, amount of intraoperative bleeding, intraoperative fluoros copy time, Majeed pelvic score at final follow‐up, and quality of fracture reduction based on Mears and Velyvis's imaging classification criteria were collected by the same researcher and compared statistically.

Results

All patients were continuously followed up for 23.17 ± 3.34 months (range, 12 to 46 months). All sacral fractures healed with an average healing time of 9.3 ± 2.24 months (range, 6 to 18 months). None of the patients had re‐displacement of the fracture or fixation failure. Compared to the iliosacral screw group, the posterior INFIX group patients had more intraoperative bleeding (t = 3.59, P < 0.001), shorter operation time (t = 4.49, P < 0.001), and shorter intraoperative fluoroscopy time (t = 6.26, P < 0.001). There were no statistical differences between the two groups in terms of age, sex, fracture type, Majeed score, and quality of fracture reduction (P > 0.05). In the posterior INFIX group, one patient had a superficial wound infection and one patient complained of discomfort due to a prominent fixation. In the iliosacral screw fixation group, one patient had intraoperative iatrogenic S1 nerve injury and vessel injury. The posterior INFIX fixation was a simpler manipulation with higher safety, shorter time of operation and intraoperative fluoroscopy, and similar clinical outcomes compared to iliosacral screw fixation.

Conclusion

For the treatment of unilateral unstable sacral fractures, the posterior INFIX fixation can be recommended in clinic application.

Complications and outcomes in 69 consecutive patients with floating hip

BACKGROUND

Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.

HYPOTHESIS

A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate.

METHODS

Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring.

RESULTS

We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities.

CONCLUSION

Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C).

LEVEL OF EVIDENCE

IV; retrospective study.

Infection after the use of INFIX in Pelvic Ring Injuries

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.

A systematic review of the transiliac internal fixator (TIFI) for posterior pelvic injuries

OBJECTIVE

To summarize the literature on transiliac internal fixator (TIFI) indications and outcomes for treating posterior pelvic ring injuries.

METHODS

We searched databases for original publications in journals. Biomechanical and clinical studies using a TIFI for posterior pelvic ring injuries were considered for inclusion. The dates of publications that were included ranged from January 2000 until December 2020.

RESULTS

A total of 13 articles were reviewed, including eight clinical studies and five biomechanical tests. We found only case series and no multicenter or randomized study. The clinical studies contained data for a total of 186 cases, including indications, treatments, complications, and outcomes, with a minimum follow-up time of 12 months. All studies reported superior results according to operation time, blood loss, complication, dislocation, and union. One biomechanical test evaluated inferior results.

CONCLUSIONS

The TIFI is a user-friendly and safe device to treat posterior pelvic injuries. It can also be used for acute, high-impact injuries, and fragility fractures. Nevertheless, there is no evidence concerning which types of pelvic fractures are most beneficial. Therefore, further biomechanical and clinical studies are necessary to resolve this question.

Does surgical treatment for unstable fragility fracture of the pelvis promote early mobilization and improve survival rate and postoperative clinical function?

PURPOSE

This retrospective multicenter study aimed to compare rates of early mobilization and survival and functional outcome of surgical treatment (S) with that of conservative treatment (C) according to each unstable fragility fracture of the pelvis (FFP) classification type with displacement of the posterior component ≥ 5 mm.

METHODS

We analyzed 64 patients with unstable type III and IV FFP who could move and transfer themselves before injury and had ≥ 5 mm displacement of the posterior component. We compared survival rate, early mobilization, walking ability at final follow-up, and complications at admission for each type of surgical and conservative treatment.

RESULTS

Most of the unstable FFP were type IIIa and IVb in the study population. Type III comprised 40 cases (group S:13/group C:27) and type IV comprised 24 cases (group S:7/group C:17). There were no significant differences in 3 month and 1 year survival rates, although group C (III) had the tendency of higher mortality rate (p = 0.08). Mobilization (transferring to a wheelchair) was enabled significantly earlier in group S (III) than in group C (III) (p = 0.02), but in type IV, most patients enabled early mobilization even without surgical intervention. There were no significant differences in hospital complications and walking ability at final follow-up.

CONCLUSION

In this study, the superiority of surgical treatment for unstable FFP was not proven. However, the results suggest that type IVb may be a relatively stable type compared to type III and that type IVb should be considered separately from bilaterally complete unstable sacral fractures due to high-energy trauma.

Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases

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.

Management of pelvic injuries in hemodynamically unstable polytrauma patients - Challenges and current updates

Pelvic injuries are notorious for causing rapid exsanguination, and also due to concomitant injuries and complications, they have a relatively higher mortality rate. Management of pelvic fractures in hemodynamically unstable patients is a challenging task and has been variably approached. Over the years, various concepts have evolved, and different guidelines and protocols were established in regional trauma care centers based mainly on their previous experience, outcomes, and availability of resources. More recently, damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation are being employed in the management of these unstable injuries, without clear consensus or guidelines. In this background, we have performed a computerized search using the Cochrane Database of Systematic Reviews, Scopus, Embase, Web of Science, and PubMed databases on studies published over the past 30 years. This comprehensive review aims to consolidate available literature on the current epidemiology, diagnostics, resuscitation, and management options of pelvic fractures in polytraumatized patients with hemodynamic instability with particular focus on damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation.

An overview of the key principles and guidelines in the management of pelvic fractures

Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient’s journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.

Effectiveness of anterior subcutaneous internal fixation (INFIX) in the management of potentially infected pelvis fractures

BACKGROUND

Anterior plating is the treatment of choice in anterior pelvic ring fractures. In certain situations where pelvis fracture is associated with open wound, infection, abdominal injury or bladder injury - internal fixation with plate is contraindicated. Conventionally, external fixation is done in such cases. However, External Fixation is associated with pin tract infection, pin loosening, difficult wound care and less patient compliance. The present study was conducted to evaluate a possible 'middle path' between the two procedures.

METHODS

A prospective study was conducted from July 2017 to December 2019.18 adult patients with risk of infection were treated with INFIX. The patients' data was collected on presentation, preoperatively, intra-operatively and post operatively. The patients were followed up with serial radiographs. Functional status was assessed using Iowa Pelvis Score. After radiological union, implant removal was performed. The patients were followed up for a minimum of 6 months after the removal surgery.

RESULTS

The average age of patients in present study was 39.55 years with a male predominance. 16 out of 18 patients were polytrauma cases with ISS more than 15.50% patients had Lateral Compression type of fracture. Radiological union was seen at an average of 3.5 months. After removal, 78% patients had excellent outcome and 22% patients had good outcome. The complications observed were LFCN irritation (27.78%) and asymptomatic heterotopic ossification (22%).

CONCLUSION

Present study concludes that INFIX produces excellent outcome in pelvis fractures with risk of infection where anterior plating is contraindicated.

Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review

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.