A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury

Abstract

Background The aim of this study is to compare the clinical and biomechanical outcome of INFIX plus single with two sacroiliac screw fixation for unstable pelvic fractures of Type C. Methods Sixteen cadavers were randomly subjected to INFIX plus single or double sacroiliac screw fixations and then mounted onto the ElectroForce loading machine under different vertical loads. To investigate the clinical outcomes of the two techniques, nineteen patients were retrospectively analyzed. The main outcome measures were postoperative radiographic reduction grading (using the Tornetta and Matta grading system), functional outcome (using the Majeed scoring system), and incidence of complications. Results In the biomechanical study, INFIX plus double sacroiliac screw fixation showed better biomechanical stability than fixation with a single sacroiliac screw (p < 0.05). In our clinical case series, all 19 patients had bony union 6 months after the operation. INFIX plus double sacroiliac screw fixation also demonstrated a better functional outcome and a higher radiographic satisfactory rate than INFIX plus single sacroiliac screw fixation (79.25 ± 5.47; 91.33 ± 4.97; p < 0.05), (77.78% vs. 60%; p = 0.05). One patient in INFIX plus single-screw fixation group had screw loosening at 6-month follow-up postoperatively. One case in each group suffered heterotopic ossification and the lateral femoral cutaneous nerve paralysis, and one patient suffered from infection. Conclusion INFIX plus double sacroiliac screw fixation demonstrated more stability in cadaveric biomechanical analysis and better clinical outcomes than INFIX plus single sacroiliac screw fixation.

Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case–control study

“…In addition, the study revealed that compared to the canulated screw, the elastic nail exhibited significantly lower peak stress and a more dispersed stress distribution, suggesting better biocompatibility. Previous research has confirmed the biomechanical stability of INFIX for anterior pelvic ring injuries 23 , 28 , 29 . However, ESIN proved superior in stability compare to INFIX, both globally and locally.…”

Intraoperative CT-assisted sacroiliac screws fixation for the treatment of posterior pelvic ring injury: a comparative study with conventional intraoperative imaging

“…Studies have shown that the probability of implant failure is different when only the posterior ring fixation is used in the case of instability of the posterior and/or anterior ring instability. In elderly patients, the failure rate of single-screw fixation was 12% when the posterior ring was injured alone and can be as high as 55% when the anterior and posterior ring were unstable simultaneously 13 . In our study, wound discharge was found to be a common complication, mostly related to the liquefaction of fat at the wound site.…”

“…When axial loading reaches 400 N to 800 N, no difference in posterior pelvic ring stability between the single- and double-screw fixation techniques. However, if combined with anterior pelvic ring injury, significant differences will emerge 13 . Stabilizing both S1 and S2, preferably with trans-sacral screws, could probably reduce the re-operation rate 14 .…”

Clinical study of modified INFIX combined with sacroiliac joint screws for pelvic instable injuries

“…Most of the anterior pelvic rings are located subcutaneously and are easily damaged when subjected to external forces, resulting in a breakdown of the integrity and stability of the pelvis [2,3]. Currently, the mainstream treatment methods for anterior pelvic ring injuries include external xation, internal xation with incisional repositioned plates, and INFIX [4]. External pelvic xation frame is commonly used in patients with multiple trauma and hemodynamic instability, which can quickly stabilize and reduce the volume of the pelvic ring, reduce the "chimney effect" caused by pelvic ring rupture, and reduce bleeding [5].…”

“…Many scholars believe that incision and plate xation of the anterior pelvic ring is the best treatment method because the fracture end can be repositioned under direct vision after incision, and the plate and screws can obtain good repositioning effect and biomechanical stability [4,9]. However, the disadvantages of large bleeding, vascular nerve injury, incisional infection, extensive periosteal debridement, and complicated surgical operation have seriously limited the further application of this technique [10].…”