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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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Tao X, Lyu F, Sugand K, Zhou K, Wang H. Does a novel 3D printed individualized guiding template based on cutaneous fiducial markers contribute to accurate percutaneous insertion of pelvic screws? A preliminary phantom and cadaver study. BMC Surg 2024; 24:105. [PMID: 38614998 PMCID: PMC11015658 DOI: 10.1186/s12893-024-02402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/04/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Most 3D-printed guiding templates require dissection of soft tissues to match the corresponding surfaces of the guiding templates. This study sought to explore the accuracy and acceptability of the novel 3D printed individualized guiding templates based on cutaneous fiducial markers in minimally invasive screw placement for pelvic fractures. METHODS The printed template was tested on five high-fidelity biomimetic phantom models of the bony pelvis and its surrounding soft tissues as well as on two fresh frozen cadavers. Four cutaneous fiducial markers were transfixed on each phantom model prior to performing CT scans to reconstruct their 3D models. Personalized templates for guiding screw insertion were designed based on the positions of the fiducial markers and virtually planned target screw channels after scanning, followed by 3D printing of the guide. Phase 1 consisted of five expert surgeons inserting one anterograde supra-pubic screw and one sacroiliac screw percutaneously into each phantom model using the 3D-printed guide. The deviation of screw positions between the pre-operative planned and post-operative actual ones was measured after registering their 3D modelling. A Likert scale questionnaire was completed by the expert surgeons to assess their satisfaction and acceptability with the guiding template. Phase 2 consisted of repeating the same procedures on the fresh frozen cadavers in order to demonstrate face, content and concurrent validity. RESULTS In Phase 1, all ten screws were successfully implanted with the assistance of the guiding template. Postoperative CT scans confirmed that all screws were safely positioned within the bony pelvic channels without breaching the far cortex. The mean longitudinal deviation at the bony entry point and screw tip between the pre-operative planned and post-operative actual screw paths were 2.83 ± 0.60 mm and 3.12 ± 0.81 mm respectively, with a mean angular deviation of 1.25 ± 0.41°. Results from the Likert questionnaire indicated a high level of satisfaction for using the guiding template among surgeons. In Phase 2, results were similar to those in Phase 1. CONCLUSIONS The 3D-printed guiding template based on cutaneous fiducial markers shows potential for assisting in the accurate insertion of percutaneous screws in the pelvis.
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Affiliation(s)
- Xingguang Tao
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Lyu
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Kapil Sugand
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Kaihua Zhou
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huixiang Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zhao P, Li R, Liu L, Wang X, Chen X, Guan J, Wu M. Clinical study of modified INFIX combined with sacroiliac joint screws for pelvic instable injuries. BMC Surg 2023; 23:350. [PMID: 37974146 PMCID: PMC10655463 DOI: 10.1186/s12893-023-02205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/23/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The INFIX technique is becoming one of the most commonly performed surgical procedures for anterior pelvic ring instability injuries. The purpose of this article is to compare the clinical outcomes of modified anterior subcutaneous internal fixation (M-INFIX) with conventional anterior subcutaneous internal fixation (C-INFIX) for anterior pelvic ring instability injuries. PATIENTS AND METHODS A retrospective analysis of 36 cases of unstable pelvic injuries treated operatively at our institution, 20 of which were treated with C-INFIX and 16 with M-INFIX. Data collected included age, gender, ISS score, fracture typing, operative time, operative bleeding, postoperative complications, fracture healing time, Matta score, Majeed score, and follow-up time. Statistical sub-folding of each variable between the two groups was performed. RESULTS There was no statistical difference between the C-INFIX and M-INFIX groups in terms of age, gender, ISS (Injury Severity Score), follow-up time, fracture typing, fracture healing time, and Majeed score (P > 0.05). the M-INFIX had a significantly lower incidence of postoperative complications than the C-INFIX group, especially in the incidence of Lateral femoral cutaneous nerve (LFCN) injury (P < 0.05). In contrast, the M-INFIX group had statistically higher operative time, intraoperative bleeding, and Matta score than the C-INFIX group (P < 0.05). CONCLUSION This study was based on a modified application of the surgical experience with C-INFIX and showed better clinical outcomes in terms of complication rates and quality of repositioning than the conventional surgical approach. These findings indicate that further analytical studies of this study would be valuable.
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Affiliation(s)
- Peishuai Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Renjie Li
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Leyu Liu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiaopan Wang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiaotian Chen
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Jianzhong Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.
| | - Min Wu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.
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Hempen EC, Wheatley BM, Schimoler PJ, Kharlamov A, Melvin PR, Miller MC, Altman GT, Altman DT, Westrick ER. A biomechanical comparison of superior ramus plating versus intramedullary screw fixation for unstable lateral compression pelvic ring injuries ,,. Injury 2022; 53:3899-3903. [PMID: 36182593 DOI: 10.1016/j.injury.2022.09.027] [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: 02/08/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of the anterior component of unstable lateral compression (LC) pelvic ring injuries remains controversial. Common internal fixation options include plating and superior pubic ramus screws. These constructs have been evaluated in anterior-posterior compression (APC) fracture patterns, but no study has compared the two for unstable LC patterns, which is the purpose of this study. METHODS A rotationally unstable LC pelvic ring injury was modeled in 10 fresh frozen cadaver specimens by creating a complete sacral fracture, disruption of posterior ligaments, and ipsilateral superior and inferior rami osteotomies. All specimens were repaired posteriorly with two fully threaded 7 mm cannulated transiliac-transsacral screws through the S1 and S2 corridors. The superior ramus was repaired with either a 3.5 mm pelvic reconstruction plate (n = 5) or a bicortical 5.5 mm cannulated retrograde superior ramus screw (n = 5). Specimens were loaded axially in single leg support for 1000 cycles at 400 N followed by an additional 3 cycles at 800 N. Displacement and angulation of the superior and inferior rami osteotomies were measured with a three-dimensional (3D) motion tracker. The two fixation methods were then compared with Mann-Whitney U-Tests. RESULTS Retrograde superior ramus screw fixation had lower average displacement and angulation than plate fixation in all categories, with the motion at the inferior ramus at 800 N of loading showing a statistically significant difference in angulation. CONCLUSION Although management of the anterior ring in unstable LC injuries remains controversial, indications for fixation are becoming more defined over time. In this study, the 5.5 mm cannulated retrograde superior ramus screw significantly outperformed the 3.5 mm reconstruction plate in angulation of the inferior ramus fracture at 800 N. No other significance was found, however the ramus screw demonstrated lower average displacements and angulations in all categories for both the inferior and superior ramus fractures.
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Affiliation(s)
- Eric C Hempen
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Benjamin M Wheatley
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Patrick J Schimoler
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA; Departments of Mechanical Engineering and Materials Science and Bioenginering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexander Kharlamov
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Patricia R Melvin
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark Carl Miller
- Departments of Mechanical Engineering and Materials Science and Bioenginering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Gregory T Altman
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Daniel T Altman
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Edward R Westrick
- Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, USA
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Song Y, Shao C, Yang X, Lin F. Biomechanical study of anterior and posterior pelvic rings using pedicle screw fixation for Tile C1 pelvic fractures: Finite element analysis. PLoS One 2022; 17:e0273351. [PMID: 36006983 PMCID: PMC9409507 DOI: 10.1371/journal.pone.0273351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Yuanzheng Song
- Department of Orthopaedics, Tengzhou Central People’s Hospital Affiliated to Jining Medical University, Tengzhou, Shandong Province, China
| | - Changsheng Shao
- Department of Orthopaedics, Tengzhou Central People’s Hospital Affiliated to Jining Medical University, Tengzhou, Shandong Province, China
| | - Ximing Yang
- Department of Orthopaedics, Tengzhou Central People’s Hospital Affiliated to Jining Medical University, Tengzhou, Shandong Province, China
- * E-mail:
| | - Feng Lin
- Department of Orthopaedics, Tengzhou Central People’s Hospital Affiliated to Jining Medical University, Tengzhou, Shandong Province, 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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Hiyama A, Ukai T, Nomura S, Watanabe M. The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note. J Orthop Surg Res 2022; 17:32. [PMID: 35033130 PMCID: PMC8761317 DOI: 10.1186/s13018-022-02920-0] [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: 07/24/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture. Methods A typical case is presented in this study. An 86-year-old woman suffered from an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation were selected to optimize surgical invasiveness and proper implant placement. Results The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon. Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. Conclusions The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-02920-0.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Taku Ukai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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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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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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Yu X, Wang Q, Ma Y, Qiu J, Zhao L, Sui J, Ni Y. [Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1555-1560. [PMID: 33319535 DOI: 10.7507/1002-1892.202006145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures. Methods The clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation. Results The patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group ( t=-11.965, P=0.000; t=-20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups ( P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group ( P>0.05), but there were significant differences in sitting and sexual intercourse scores ( t=-4.250, P=0.003; t=-6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group ( P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group ( P<0.05). Conclusion Compared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.
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Affiliation(s)
- Xiao Yu
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, P.R.China;Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, P.R.China
| | - Qiang Wang
- Department of Orthopedics, Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210000, P.R.China
| | - Yong Ma
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, P.R.China;Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, P.R.China
| | - Junjun Qiu
- Department of Orthopedics, Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210000, P.R.China
| | - Lei Zhao
- Department of Orthopedics, Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210000, P.R.China
| | - Jisheng Sui
- Department of Orthopedics, Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210000, P.R.China
| | - Yan Ni
- Department of Orthopedics, Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210000, P.R.China
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11
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Hack J, Kranz Y, Knauf T, Bäumlein M, Malcherczyk D, Ruchholtz S, Oberkircher L. Stability of internal versus external fixation in osteoporotic pelvic fractures - a biomechanical analysis. Injury 2020; 51:2460-2464. [PMID: 32800315 DOI: 10.1016/j.injury.2020.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 07/22/2020] [Accepted: 08/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoporosis-related fragility fractures of the pelvic ring (FFP) differ fundamentally from pelvic fractures in younger patients. However, very little is known about biomechanical stability of different osteosynthesis procedures addressing the anterior pelvic ring in these fractures. The aim of this study was to compare standard external fixation with internal fixation using a novel screw-and-rod system in osteoporotic fractures of the pelvic ring in terms of stiffness, plastic deformation and maximum load under cyclic loading in a human cadaveric model. MATERIALS AND METHODS A total of 18 embalmed osteoporotic cadaver pelvis specimens were randomized based on the T-score into a group for external fixation and a group for internal fixation. FFP type-IIB fractures were created. In addition to the external or internal fixator, a cement-augmented sacroiliac screw was implanted. Afterwards, axial cyclic loading was performed in a testing setup simulating one-leg stand. RESULTS Mean plastic deformation and stiffness both were significantly better in the internal fixation group than in the external fixation group (plastic deformation: 0.37 mm (SD: 0.23) versus 0.71 mm (SD: 0.26), p = 0.011; stiffness: 43.69 N/mm (SD: 18.39) versus 26.52 N/mm (SD: 9.76), p = 0.029). Maximum load did not differ significantly between internal fixator (506.3 N; SD: 129.4) and external fixator (461.1 N; SD: 147.4) (p = 0.515). CONCLUSIONS Submuscular internal fixation might be an interesting alternative to external fixation in clinical practice because of better biomechanical properties as well as several advantages in clinical use.
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Affiliation(s)
- J Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany.
| | - Y Kranz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - T Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - M Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - D Malcherczyk
- Clinic for Orthopaedics and Trauma Surgery, Klinikum Fulda, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - L Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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12
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Sun X, Yan H, Wang J, Liu Z, Tian W, Jia J. Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture. Medicine (Baltimore) 2020; 99:e20652. [PMID: 32791662 PMCID: PMC7386985 DOI: 10.1097/md.0000000000020652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation.We retrospectively reviewed 18 patients (aged 25-62, 34.2 ± 7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ± 3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed.The operation time ranged from 30 to 65 minutes (42.8 ± 18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ± 22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ± 4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ± 2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation.Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.
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Affiliation(s)
- Xiaochen Sun
- Department of Orthopaedic Surgery, Tianjin Haihe Hospital
| | - Huimin Yan
- Department of Orthopaedic Surgery, Tianjin Haihe Hospital
| | - Jianmin Wang
- Department of Orthopaedic Surgery, Da Feng Tong Ren hospital of Yancheng, Jiangsu
| | - Zhaojie Liu
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Wei Tian
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Jian Jia
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
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13
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Liu L, Fan S, Chen Y, Peng Y, Wen X, Zeng D, Song H, Jin D. Biomechanics of Anterior Ring Internal Fixation Combined with Sacroiliac Screw Fixation for Tile C3 Pelvic Fractures. Med Sci Monit 2020; 26:e915886. [PMID: 32163378 PMCID: PMC7092661 DOI: 10.12659/msm.915886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Despite the development of minimally invasive techniques for pelvic fractures, performing minimally invasive surgery for Tile C3 pelvic fractures remains challenging. Thus, we propose use of anterior ring internal fixation combined with sacroiliac screw fixation for Tile C3 pelvic fractures. Material/Methods A normal pelvic finite element model (model 1) was established. Two-screw, three-screw, and four-screw anterior ring internal fixators and plate combined with sacroiliac screw Tile C3 pelvic fracture models (models 2, 3, 4, and 5, respectively) were also established. A vertical load of 600 N was applied on S1. The distribution of displacement and stress in the standing and sitting positions was compared. Results Models 2, 3, 4, and 5 can provide effective fixation. Compared with model 1, in the erect position, the maximum displacement of models 2, 3, 4, and 5 increased by 66.51%, 65.36%, 35.16%, and 35.47% and the maximum stress increased by 201.78%, 130.65%, 100.82%, and 99.03%, respectively. Compared with model 1, in sitting position, the maximum displacement of models 2, 3, 4, and 5 increased by 9.1%, 11.04%, 5.57%, and 8.59% and the maximum stress increased by 157.73%, 118.02%, 98.32%, and 93.16%, respectively. Conclusions Anterior ring internal fixators combined with sacroiliac screws can effectively fix Tile C3 pelvic fractures.
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Affiliation(s)
- Lin Liu
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland).,Department of Traumatic Orthopaedics, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Shicai Fan
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Yuhui Chen
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Yongxing Peng
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Xiangyuan Wen
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
| | - Donggui Zeng
- Department of Traumatic Orthopaedics, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Hui Song
- Department of Traumatic Orthopaedics, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Dadi Jin
- Department of Traumatic Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhuo, Guangdong, China (mainland)
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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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Jordan MC, Brems AC, Heintel T, Jansen H, Hoelscher-Doht S, Meffert RH. The Anterior Subcutaneous Pelvic Ring Fixator: No Biomechanical Advantages Compared with External Fixation. J Bone Joint Surg Am 2019; 101:1724-1731. [PMID: 31577677 DOI: 10.2106/jbjs.18.01363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subcutaneous fixation of the anterior pelvic ring is an emerging surgical technique for trauma patients. The aim of this study was to biomechanically evaluate 2 internal fixation devices for stabilizing a disrupted pelvic ring and compare them with traditional external fixation. METHODS Thirty-six synthetic pelvises with a simulated unstable ring fracture (anteroposterior compression type III) were divided into 3 groups. Group A underwent fixation with a supra-acetabular external fixator; group B, with an internal fixator using the USS II polyaxial system; and group C, with an internal fixator using the Click'X polyaxial system. Biomechanical testing included measurement of peak-to-peak displacement at 300, 400, and 500 N; total displacement; plastic deformation; stiffness; and fracture-line displacement. RESULTS Statistical analysis of all measured parameters revealed no significant differences among the groups. However, vertical displacement of the preshaped connecting rod within the screw heads occurred as a result of inadequate stability of the internal fixation at the rod-screw interface. CONCLUSIONS Although internal fixator devices are placed close to the bone and should therefore maintain greater stiffness, our data did not support the hypothesis of superior stability. Special attention is required when using a curved connecting rod as the rod is easily displaced, placing relevant anatomical structures at risk. These devices require further refinement to avoid potential patient injury.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
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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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Abstract
We describe the case of an 8-year old female patient with an open pelvic fracture after being run over by a bus. Open pelvic injuries in pediatric patients are very rare and are associated with high mortality rates and long-term morbidity. In this case, a multidisciplinary surgical approach is described. The injuries include a complex pelvic ring fracture, which was treated with an internal external fixator, together with severe urogenital and soft-tissue injury. The internal external fixator, a surgical technique involving a temporary internal fixation device, is well described in adults, but has not been described in pediatric patients before. This case presentation shows the severity and complexity of the treatment of open pelvic fractures with severe associated injures. Albeit the treatment of her orthopaedic injuries has been successful so far, our patient unfortunately still suffers notable morbidity from her other injuries.
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18
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Steer R, Balendra G, Matthews J, Wullschleger M, Reidy J. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J 2019; 5:22. [PMID: 31250805 PMCID: PMC6598424 DOI: 10.1051/sicotj/2019019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/02/2019] [Indexed: 11/14/2022] Open
Abstract
Purpose: Pelvic anterior internal fixators (INFIX) are a relatively new alternative in the treatment of unstable pelvic fractures. The authors wanted to review the use of complications and outcomes of this method of pelvic fixation at our institution. Method: Patients over the age of 18 who had an INFIX used in treatment of their pelvic ring injury were identified. Patient demographics, fracture type, injury severity score, morbidity, complications and time until removal were recorded. All available patients were followed up following the removal of the INFIX and completed an Iowa Pelvic Score (IPS) at this time. Results and Discussion: 24 patients (19 male) with a mean age of 38.5 (range 18–71) met the inclusion criteria with an average injury severity score of 29.8 (10–66). The most common complication following insertion was a lateral femoral cutaneous nerve (LFCN) injury, which occurred in 11 patients (bilaterally in two), 6 patients (25%) had ongoing numbness 6 months post removal. Two patients had an infection, one of which prompted the removal of the INFIX. One INFIX was removed for implant failure. All other removals were planned electively. Heterotopic ossification was noted to have occurred in five cases. The mean IPS following removal of the INFIX was 79.2 (52–100). INFIX is a safe and successful treatment for unstable pelvic ring injuries. Overall, patients tolerate the INFIX well with good outcome scores. The main concern being the high rate of LFCN injuries, although many resolved after removal of the INFIX.
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Affiliation(s)
- Richard Steer
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, QLD, Australia - University of Queensland, St Lucia 4072, QLD, Australia
| | - Ganesh Balendra
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, QLD, Australia
| | - Justin Matthews
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, QLD, Australia
| | - Martin Wullschleger
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, QLD, Australia - Griffith University, 58 Parklands Drive, Southport 4215, QLD, Australia
| | - James Reidy
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, QLD, Australia - Griffith University, 58 Parklands Drive, Southport 4215, QLD, Australia
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Abstract
Pelvic ring fractures are rare injuries in the elderly though the incidence is increasing due to the increasing age of the population. Main goal of treatment is the quickest possible re-mobilization to prevent side-effects of immobilization such as osteopenia, pulmonary infections or thromboembolic events. Isolated anterior pelvic ring fractures are stable injuries and therefore they usually can be treated conservatively, while pelvic ring injuries with involvement of the posterior ring are considered unstable and should undergo surgical stabilization if the patient’s condition allows for it. Conservative treatment includes adequate analgesia, guided mobilization with partial weight bearing if possible and osteoanabolic medication. The appropriate surgical procedure should be discussed in an interdisciplinary round considering patient’s pre-injury condition, anaesthetic and surgical risks.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180062
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Affiliation(s)
- Markus A Küper
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany
| | - Alexander Trulson
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany
| | - Fabian M Stuby
- BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany
| | - Ulrich Stöckle
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany
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20
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Booth A, Ingoe HMA, Northgraves M, Coleman E, Harden M, Kassam J, Kwok I, Hilton C, Bates P, McDaid C. Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review. BMJ Open 2019; 9:e024737. [PMID: 31110085 PMCID: PMC6530388 DOI: 10.1136/bmjopen-2018-024737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To undertake a systematic review of the evidence base for the effectiveness of surgical fixation of lateral compression (LC-1) fragility fractures of the pelvis compared with non-surgical approaches. SEARCHES MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and two international trials registers were searched up to January 2017 (MEDLINE to February 2019) for studies of internal or external fixation of fragility fractures of the pelvis. PARTICIPANTS Patients with lateral compression pelvic fractures, sustained as the result of a low-energy mechanism, defined as a fall from standing height or less. INTERVENTIONS Surgery using either external or internal fixation devices. Conservative non-surgical treatment was the defined comparator. OUTCOME MEASURES Outcomes of interest were patient mobility and function, pain, quality of life, fracture union, mortality, hospital length of stay and complications (additional operative procedures, number and type of adverse events and serious adverse events). QUALITY ASSESSMENT AND SYNTHESIS The Joanna Briggs Institute Checklist for Case Series was used to assess the included studies. Results were presented in a narrative synthesis. RESULTS Of 3421 records identified, four retrospective case series met the inclusion criteria. Fixation types were not consistent between studies or within studies and most patients had more than one type of pelvic fixation. Where reported, mobility and function improved post-surgery, and a reduction in pain was recorded. Length of hospital stay ranged from 4 days to 54 days for surgical fixation of any type. Reported complications and adverse outcomes included: infections, implant loosening, pneumonia and thrombosis. Use of analgesia was not reported. CONCLUSIONS There is insufficient evidence to support guidance on the most effective treatment for patients who fail to mobilise after sustaining an LC-1 fragility fracture. TRIAL REGISTRATION NUMBER CRD42017055872.
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Affiliation(s)
- Alison Booth
- Department of Health Sciences, University of York, York, UK
| | - Helen Margaret Ann Ingoe
- Department of Health Sciences, University of York, York, UK
- Trauma and Orthopaedics, The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
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Long T, Li KN, Gao JH, Liu TH, Mu JS, Wang XJ, Peng C, He ZY. Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures. Orthop Surg 2019; 11:386-396. [PMID: 31077570 PMCID: PMC6595115 DOI: 10.1111/os.12461] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives To analyze the curative effect of TiRobot surgical robotic navigation and location system‐assisted percutaneous sacroiliac screw fixation and percutaneous sacroiliac screw by traditional fluoroscopy, and to summarize the safety and benefits of TiRobot. Methods A total of 91 patients with pelvic posterior ring fractures from December 2015 to February 2018 were included in this study. According to the surgical methods selected by the patients, the patients were divided into a TiRobot surgical robotic navigation and location system group (TiRobot group) and a percutaneous sacroiliac screw fixation group (traditional group). Statistical indicators included the number of sacroiliac screws, the time of planning the sacroiliac screw path, fluoroscopy frequency, fluoroscopy time, operation time, length of incision, blood loss, anesthesia time, the healing process of skin incisions, and fracture healing time. Fracture reduction was evaluated according to the maximum displacement degree at the inlet and outlet view X‐ray or CT. Matta standard was used to evaluate fracture reduction. At the last follow‐up, the Majeed function system was used to evaluate the function. Results All patients were followed up for 8 to 32 months. A total of 66 sacroiliac screws were implanted in the TiRobot group. A total of 43 sacroiliac screws were implanted in the traditional group. There were statistically significant differences in terms of fluoroscopy frequency, fluoroscopy time, operation time, incision length, anesthesia time, and blood loss between the two groups; the TiRobot group was superior to the traditional group. The healing time of the TiRobot group and the traditional group was 4.61 ± 0.68 months (range, 3.5–6.3 months) and 4.56 ± 0.78 months (range, 3.4–6.2 months), respectively, and there was no statistical difference. Postoperatively, by Matta standard, the overall excellent and good rate of fracture reduction was 89.28% and 88.57%, respectively. At the last follow‐up, by Majeed function score, the overall excellent and good rate was 91.07% and 91.43%. There was no statistical difference between the two groups. Conclusion Sacroiliac screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures has the characteristics of less trauma, shorter operation time, and less blood loss. TiRobot has the characteristics of high safety and accuracy and has great clinical application value.
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Affiliation(s)
- Tao Long
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Kai-Nan Li
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Jin-Hua Gao
- Department of Orthopaedic Surgery, The First People's Hospital of Anqing, Anqing, China
| | - Tian-Hu Liu
- Department of Orthopaedic Surgery, The People's Hospital of Pixian, Chengdu, China
| | - Jian-Song Mu
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xue-Jun Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Chao Peng
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Zhi-Yong He
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
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22
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Hua X, Yan SG, Cui Y, Yin Z, Schreiner AJ, Schmidutz F. Minimally invasive internal fixator for unstable pelvic ring injuries with a pedicle screw-rod system: a retrospective study of 23 patients after 13.5 months. Arch Orthop Trauma Surg 2019; 139:489-496. [PMID: 30535810 DOI: 10.1007/s00402-018-3094-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Pelvic ring fractures are challenging injuries and require effective treatment due to the frequently compromised patient condition. The aim of this study was to evaluate the outcome of unstable pelvic ring injuries treated with a minimally invasive pedicle screw-rod system. METHODS Retrospective analysis was performed for patients with an unstable pelvic ring injury that were treated with a minimally invasive anterior internal pelvic fixator (INFIX) with or without a posterior pedicle screw-rod fixator (6/2012-4/2015). The quality of reduction was evaluated by the Tornetta and Matta criteria and the clinical outcome was evaluated by the Majeed scores. Further evaluation included the operation time, intraoperative blood loss, and complication rate. RESULTS A total of 23 patients (12 males and 11 females) with a mean age of 37.6 years (range 10-65 years) and a follow-up of 13.5 months (6-27 months) were evaluated. The Tile classification showed 13 type B (B1 = 6, B2 = 4, and B3 = 3) and 10 type C (C1 = 7 and C2 = 3) fractures. Mean operation time and intraoperative blood loss were 24.8 min (20-30 min) and 20.4 ml (16-29 ml) for an anterior INFIX (n = 13), and 60 min (45-70 min) and 150 ml (115-168 ml) when combined with a posterior pedicle screw-rod fixator (n = 10). Quality of reduction was excellent in 13, good in 6, and fair in 4 patients, with no signs of heterotopic ossification. Clinical results after 6 months were excellent in 14 patients, good in 6, fair in 2, and poor in 1. Unilateral thigh paresthesia was seen in 2 patients which resolved after implant removal. CONCLUSIONS The INFIX appears to be a safe and minimally invasive surgical technique which can effectively be combined with posterior pedicle screw-rod fixation. It also can be applied for the definitive treatment of vertically and/or rotationally unstable pelvic ring injuries, especially in severely compromised patients with a high mortality risk.
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Affiliation(s)
- Xingyi Hua
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088, China.
| | - Shuang G Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088, China.,Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
| | - Yiliang Cui
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088, China
| | - Zongsheng Yin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088, China
| | - Anna J Schreiner
- BG Trauma Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Florian Schmidutz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany.,BG Trauma Center, Eberhard Karls University Tübingen, Tübingen, Germany
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23
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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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24
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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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25
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Rickman M, Link BC, Solomon LB. Patient Weight-bearing after Pelvic Fracture Surgery-A Systematic Review of the Literature: What is the Modern Evidence Base? Strategies Trauma Limb Reconstr 2019; 14:45-52. [PMID: 32559267 PMCID: PMC7001596 DOI: 10.5005/jp-journals-10080-1414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Little attention in the literature appears to have been paid to the issue of postoperative weight-bearing protocols for different injury patterns after pelvic fracture surgery. The primary aim of this study is to review the currently available literature to define the level of available evidence used to inform surgical decisions on weight-bearing after pelvic fracture surgery. Secondary aims are to assess the published methods of fracture classification, surgical management, and assessment or reporting of patient outcomes. Methods A systematic review of the English language literature from 1990 to 2016 was undertaken. Eligible papers were all papers reporting minimum 6-month outcomes following surgery for pelvic fractures in adults. Exclusion criteria included pathological fractures or those resulting from penetrating injury, solely osteoporotic fractures, or series with less than 6 months of follow-up data. Results There is very little published scientific data to inform the treating surgeon on postoperative weight-bearing protocols after pelvic fracture surgery, with no randomized trials and only 1 paper out of 122 stating this as a primary aim. More than half of the papers published did not state what postoperative protocol was employed. There is no standardization of outcome measures, with less than 20% of papers using the most common validated outcome scoring system; in contrast, there is good agreement on the use of either the Tile (75%) or Burgess and Young (20%) classification. Limitations Due to the lack of published studies looking at the topic of postoperative weight-bearing after pelvic fractures, no specific recommendations are possible. As large numbers of papers were included, they were not individually assessed for bias. Conclusion A review of postoperative weight-bearing regimes reveals a nonexistent scientific evidence base from which to make recommendations, although a consensus strategy has been identified. Future research needs to be directed at this topic, as has already been the case in numerous other fracture areas, since the advantages of early mobility are potentially significant. The reported methodology for assessing and reporting patient outcomes after pelvic fracture surgery reveals no consistent standards, and the majority of papers use no specific outcome scoring system. How to cite this article Rickman M, Link B-C, Solomon LB. Patient Weight-bearing after Pelvic Fracture Surgery-A Systematic Review of the Literature: What is the Modern Evidence Base? Strategies Trauma Limb Reconstr 2019;14(1):45-52.
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Affiliation(s)
- Mark Rickman
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Bjorn-Christian Link
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
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26
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Becker CA, Kammerlander C, Cavalcanti Kußmaul A, Dotzauer F, Woiczinski M, Rubenbauer B, Sommer F, Linhart C, Weidert S, Zeckey C, Greiner A. Minimally invasive screw fixation is as stable as anterior plating in acetabular T-Type fractures - a biomechanical study. Orthop Traumatol Surg Res 2018; 104:1055-1061. [PMID: 30179721 DOI: 10.1016/j.otsr.2018.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Operative treatments of T-type acetabular fractures are challenging surgical procedures. Open reduction and internal fixation is the standard method for the operative management of these fractures, however this is associated with high blood loss, long hospital stay and longer rehabilitation. Anterior subcutaneous pelvic fixation (internal fixation=INFIX) and retrograde pubic screw fixation have shown promising results in minimally invasive treatment of pelvic ring fractures. For T-type acetabular fractures, however, minimally invasive treatment concepts are still rare. Therefore we performed a mechanical in vitro study to: - investigate the potential favorability of minimally invasive treatment options over the already established open anterior locking plate osteosynthesis of acetabular T-fractures regarding biomechanical stability and post-surgical stiffness; - explore the biomechanical feasibility of the INFIX; - assess its potential ability to reduce the anterior acetabular column. HYPOTHESIS A minimally invasive treatment of acetabular T-type fractures is biomechanically equivalent to an open anterior plate osteosynthesis. METHODS Twenty-four synthetic hemipelvis specimens with a T-type acetabular fracture were divided in four groups. A posterior column screw was placed in every pelvis of every group. The anterior column was fixed with: - anterior column screw; - anterior column screw incl. INFIX; - INFIX alone; - 14-hole angular stable locking plate (standard fixation method). Displacement of the anterior column was reduced in group 2+3 using the INFIX. All specimens were cyclically loaded with 200N until a maximum of 600N. Movement/displacement of the fracture fragments were detected with a 3D-ultrasound measuring system. Displacement (mm) and Stiffness (N/mm) of the construction were analyzed. RESULTS Statistical assessment showed no significant differences between the four fixation types (p>0.05). The 14-whole locking plate (group 4) displayed the overall highest stability with a displacement of 1.3±0.04mm and stiffness of 76.3±2.4N/mm. Anterior screw fixation (group 1) proved to be the minimally invasive fixation method with the least displacement and highest stiffness (1.5±0.2mm, 68.3±6.8N/mm). The combination of an INFIX and an anterior column screw (group 2), showed a mean stiffness of 62.1±6.0N/mm and a mean displacement of 1.7±0.2mm. INFIX only (group 3) presented a displacement of 1.6±0.1mm and a stiffness of 64.5±4.5N/mm. DISCUSSION Minimally invasive fixation techniques for T-type acetabular fractures show promising biomechanical stability in non- or slightly displaced fractures. Furthermore, INFIX could be a feasible tool for the reduction of the anterior acetabular column. LEVEL OF EVIDENCE III, case control prospective experimental study.
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Affiliation(s)
- Christopher A Becker
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Christian Kammerlander
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Fabian Dotzauer
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany; Department of trauma surgery, hospital of Schongau, Marie-Eberth-Straße 6, 86956 Schongau, Germany
| | - Matthias Woiczinski
- Department of Orthopedics, physical medicine and rehabilitation, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Bianka Rubenbauer
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Fabian Sommer
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Christoph Linhart
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Simon Weidert
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Christian Zeckey
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of general trauma & reconstructive surgery, university hospital LMU Munich, Marchioninistr 15, 81377 Munich, Germany.
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27
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Hung CC, Wu JL, Li YT, Cheng YW, Wu CC, Shen HC, Yeh TT. Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study. J Orthop Surg Res 2018; 13:238. [PMID: 30223882 PMCID: PMC6142692 DOI: 10.1186/s13018-018-0945-4] [Citation(s) in RCA: 2] [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: 07/02/2018] [Accepted: 09/06/2018] [Indexed: 01/13/2023] Open
Abstract
Background Pelvic ring injuries constitute only 2 to 8% of all fractures; however, they occur in 20% of polytrauma patients. High-energy pelvic fractures often result in mechanical instability of the pelvic ring. Successful treatment of unstable pelvic ring fractures remains a challenge for orthopedic surgeons. This study presents a novel internal fixation method for stabilizing unstable anterior pelvic ring fractures using a minimally invasive modified pedicle screw-rod fixation (MPSRF) technique. Methods This retrospective study included six patients with unstable pelvic ring injuries who underwent MPSRF, with or without posterior fixation. Intraoperative parameters such as blood loss, operative time, complications, and quality of reduction (Matta criteria) were recorded and evaluated by a blinded reviewer. Results In the present clinical series, the mean operative times and mean blood loss for unilateral versus bilateral anterior ring fixations were 176.0 min versus 295.6 min, and 153.3 mL versus 550.0 mL, respectively. No iatrogenic neuropraxia of the lateral femoral cutaneous nerve or femoral nerve palsy occurred. The reduction quality, graded by the Matta criteria, was excellent in five patients and good in one patient. Conclusions There were no infections, delayed unions, nonunions, or loss of reductions during the follow-up period. Only one patient suffered from a broken rod at 4 months postoperatively. The modified technique represents a novel, minimally invasive procedure for the treatment of anterior pelvic ring fractures and offers a reliable and effective alternative to currently available surgical techniques.
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Affiliation(s)
- Chun-Chi Hung
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei, 114, Taiwan
| | - Jia-Lin Wu
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yuan-Ta Li
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei, 114, Taiwan
| | - Yung-Wen Cheng
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei, 114, Taiwan
| | - Chia-Chun Wu
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei, 114, Taiwan
| | - Hsain-Chung Shen
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei, 114, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei, 114, Taiwan.
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28
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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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29
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Modified pedicle screw-rod fixation as a minimally invasive treatment for anterior pelvic ring injuries: an initial case series. J Orthop Surg Res 2017; 12:84. [PMID: 28587657 PMCID: PMC5461695 DOI: 10.1186/s13018-017-0590-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/31/2017] [Indexed: 12/19/2022] Open
Abstract
Background Unstable pelvic ring injuries often involve high mortality and morbidity. This study was aimed to evaluate the modified minimally invasive pedicle screw–rod fixation for anterior pelvic ring injuries, in the respects of its feasibility, merits, and limitations. Methods Twenty-three patients with unstable pelvic ring injuries underwent the modified anterior pedicle screw–rod fixation, with or without posterior fixation. The clinical outcomes were assessed using Majeed scores, and the quality of reduction was evaluated according to the criteria of Matta. Results Majeed scores showed that the clinical outcomes at postoperatively 1 year were excellent in 14 patients, good in 7, and fair in 2. One woman complained of persistent pain at the pubic tubercle during sexual intercourse. Iatrogenic neuropraxia of the unilateral lateral femoral cutaneous nerve occurred in 3 patients. Unilateral femoral nerve palsy occurred in 1 patient. The reduction was found to be excellent in 12 patients, good in 8, and fair in 3. Heterotopic ossification occurred in 8 patients, all being asymptomatic. Conclusions The modified pedicle screw–rod fixation with the minimally invasive technique offered an effective alternative for unstable anterior pelvic ring injuries.
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30
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Shetty AP, Bosco A, Perumal R, Dheenadhayalan J, Rajasekaran S. Midterm radiologic and functional outcomes of minimally-invasive fixation of unstable pelvic fractures using anterior internal fixator(INFIX) and percutaneous iliosacral screws. J Clin Orthop Trauma 2017; 8:241-248. [PMID: 28951641 PMCID: PMC5605730 DOI: 10.1016/j.jcot.2017.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/25/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Anterior pelvic external fixation is associated with pin site infections, aseptic loosening with loss of reduction, frame bulkiness hindering patient mobilization and consequent difficulties in inpatient nursing. We performed a single-center prospective series to evaluate the feasibility, safety, limitations and midterm radiologic and functional outcomes of an alternative minimally invasive pelvic internal fixation technique using an anterior subcutaneous pelvic internal fixator (INFIX) and percutaneous iliosacral screws in unstable pelvic ring fractures. METHODS Fifteen consecutive patients with vertically and/or rotationally unstable pelvic fractures, presenting to a Level-1 trauma center were treated with closed reduction, appropriate posterior stabilization with percutaneous iliosacral screws and anterior INFIX application. Outcomes were analyzed with respect to the quality of fracture reduction (Matta's radiologic criteria), ease of inpatient nursing, patient mobility and comfort, functional outcomes at final follow-up (Majeed score, SF-12 score), social reintegration and complications. RESULTS Most common injury pattern was AO/OTA type 61-C pelvic fracture in thirteen patients. Mean procedure time and intra-operative blood loss were, 57.1+/-4.9 min (range,51-68 min) and 115.3+/-26.7 ml (range,80-170 ml) respectively. Mean follow-up was 34.9+/-4.1 months (range,31-42 months). Fracture reduction was excellent in twelve and good in three patients (Matta's criteria). Functional outcomes were excellent in eight and good in seven patients (Majeed score). Mean SF-12 scores for physical and mental health were 48.58+/-5.61 and 50.89+/-3.97 respectively. Thirteen patients returned to their pre-injury jobs. All fifteen patients reintegrated into society without any restrictions. INFIX was removed at a mean post-operative period of 7.3+/-1.5 months (range,5.5-11 months). Complications included, lateral femoral cutaneous nerve irritation(n = 1), superficial wound infection(n = 1) and loss of reduction(n = 2). CONCLUSION Minimally invasive pelvic stabilization using INFIX and percutaneous iliosacral screws is easy to learn and apply, achieves good fracture reduction and definitive stabilization with minimum complications and offers excellent functional outcomes at a minimum follow-up of 31 months. LEVEL OF EVIDENCE Level IV.
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