BackgroundExternal fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod.MethodsA single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications.ResultsTwenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44–65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar.ConclusionsMinimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised.Trial registration ACTRN12616001421426. Registered 12 October 2016. Retrospectively registered.

IMN may be a superior treatment compared with anatomical locking plates for fractures of the distal femur. These findings are concordant with other data from pilot randomised studies which favour treatment of these fractures with an IMN. This study strongly supports the need for a definitive randomised trial. Cite this article: Bone Joint J 2016;98-B:846-50.

Introduction: Common peroneal nerve (CPN) injury occurs in 10-40% of patients following knee dislocation. Is magnetic resonance imaging (MRI) using routine knee protocols able to adequately evaluate CPN injury and predict long-term outcome? Methods: Trauma patients presenting for knee MRI at a single public hospital, between July 2007 and May 2017, were retrospectively identified using radiology and orthopaedic databases. Medical records were retrieved for clinical scores. MRI images were scored by two independent radiologists blinded to the clinical CPN status and scores correlated with initial clinical scores using the Pearson correlation coefficient. Results: Final cohort included 107 patients (81 males and 26 females) with a mean age of 39 (range 19-81 years). MRI was considered to be adequate for coverage of the CPN in 84 patients. Fourteen patients had CPN injury clinically (seven complete and seven partial). Concordance between MRI scores and initial clinical scores was 0.456 (P = 0.01). MRI sensitivity and specificity for CPN injury on the 84 adequate scans were 54.5% and 93.2% respectively. All seven cases of partial CPN injury and three of seven cases of complete CPN injury recovered fully. High MRI scores of 5 and 8 were given for the two patients with a persisting complete CPN palsy. Highest scores for partial CPN injury subjects were 2 and 4. Conclusions: Magnetic resonance imaging using a routine knee protocol is not adequate for the assessment of CPN injury in many subjects. More specific MRI neural sequences with complete CPN coverage may be worth trialing.

At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.

Introduction:The presentation of pelvic trauma patients can be time critical. This study will aim to identify the impact of delayed presentation in pelvic trauma patients on morbidity and mortality and identify the effect of time to pelvic surgery on patient outcomes. Methods:Patients presenting to a Level 1 Trauma Centre between July 2001 and June 2014 with major pelvic trauma were retrospectively identified using two prospective databases. Time from injury to arrival and surgery and referral from another hospital were identified. Outcomes included intensive care (ICU) admission, length of stay and mortality.Results: 1300 patients were identified. 133 (10.2%) patients were transferred from a rural hospital. The risk of death was higher in patients presenting directly (11.6% vs. 6.1%, p=0.028), although their Injury Severity Score was higher (28.1 vs. 24.0, p<0.001). There was no difference in ICU days (3.95 vs. 3.58, p=0.50) or length of stay (14.97 vs. 15.81, p=0.50). Transfer was more timely if ICU was required (17.9 vs. 46.8 hours, p=0.028). Pelvic surgery occurred in 79 (43.9%) in the transferred group and 370 (33.0%) patients presenting directly. Conclusions:Mortality is not increased with initial presentation at rural hospitals, although these patients had less severe injury. There is a higher mortality with earlier surgery, although this likely reflects the seriousness of the patient's condition rather than the surgery itself.This study aims to identify the impact delayed presentation has on morbidity and mortality in pelvic trauma patients. It will examine the effect of initial presentation at a rural or other metropolitan non-Level 1 Trauma Centre prior to definitive management at a Level 1 Trauma Centre. Finally this study will identify the effect of time to pelvic surgery on patient outcomes. MethodsA retrospective review of patients with major pelvic trauma