Anterior Subcutaneous Internal Fixation of the Pelvis: Placement of the INFIX

Chaus, George W.; Weaver, Michael J.

doi:10.1053/j.oto.2015.08.006

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…Pelvic stabilization is typically required when patients have dysfunction of the pelvic ring. Fractures that require fixation can be found in approximately 20% of poly‐trauma patients . Recently, the pelvic subcutaneous anterior internal fixation (INFIX) has been adopted as an alternative to external fixation, particularly in the obese population due to the increased amount of soft tissue in the pelvic region .…”

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confidence: 99%

“…Placement of the rod in this area avoids neurovascular and muscular impingement, allowing patient to sit or achieve a squatting position . Caution must be taken to avoid damage to the lateral femoral cutaneous nerve which usually runs across the surgical field . There is a common consensus on the location of screw insertion for the INFIX and the external fixator which is identified in the center of the anatomical teardrop of the supra‐acetabular region on the anterior pelvis .…”

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confidence: 99%

“…Caution must be taken to avoid damage to the lateral femoral cutaneous nerve which usually runs across the surgical field . There is a common consensus on the location of screw insertion for the INFIX and the external fixator which is identified in the center of the anatomical teardrop of the supra‐acetabular region on the anterior pelvis . Screw sizing is selected to maintain full intraosseous containment at the time of surgery and a wide range of diameters from 6.5 to 10 mm has been proven successful.…”

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confidence: 99%

“…Complications of this technique arise from the screws and connecting bar being inserted too deep compressing the femoral neurovascular bundle . Other authors did not mention their selected length altogether . Also, it is important to achieve total screw containment and avoid posterior cortex breaching which is determined from screw length and angles of insertion .…”

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confidence: 99%

“…Also, it is important to achieve total screw containment and avoid posterior cortex breaching which is determined from screw length and angles of insertion . With the exemption of Vaidya et al that suggested drilling of the screw in the direction of the posterior superior iliac spine just above the sciatic notch, in existing literature, screw angulation is often not disclosed . When it is disclosed, it is not supported by a criteria for its determination at time of surgery .…”

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Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

Morandi

Daily

Kee

et al. 2019

Journal Orthopaedic Research

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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°i ncrements. 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.

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