Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture

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.

Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature

“…Of the 34 studies [ 8 , 9 , 26 , 28 – 30 , 32 – 37 , 10 , 39 , 41 , 43 , 44 , 46 – 51 , 11 , 52 – 54 , 19 – 22 , 24 , 25 ] that used the Majeed Pelvic Score (MPS), in 28 of them [ 9 , 11 , 32 – 38 , 41 , 43 , 44 , 20 , 47 – 54 , 21 , 22 , 24 – 26 , 28 , 29 ] it was the only outcome instrument used. Most studies described the results in terms of the clinical grade.…”

“…Thirty-eight studies [8,9,25,26,[28][29][30][32][33][34][35][36]10,[37][38][39][40][41][42][43][44]46,47,11,[48][49][50][51][52][53][54]56,[18][19][20][21][22]24] used a pelvic-specific PROM, either as a single instrument or in combination with a generic PROM.…”

“…PROMs results. Of the 34 studies [8,9,26,[28][29][30][32][33][34][35][36][37]10,39,41,43,44,[46][47][48][49][50][51]11,[52][53][54][19][20][21][22]24,25] that used the Majeed Pelvic Score (MPS), in 28 of them [9,11,32-38,41,43,44,20,47- [8]. The mean score was 86 (range 82-90).…”

“…These were 'excellent' in 28-95% of the patients, 'good' in 5-64%, 'fair' in 0-25% and 'poor' in 0-19% of patients. Seven studies[19,38,39,46,50,51,53] only described the mean, ranging from 75 up to 95. Three studies[20,21,35] combined 'excellent' and 'good' results to 'satisfactory' (range 56-85%) and 'poor' and 'fair' to 'unsatisfactory' (range 15-37%).…”

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

“…Unstable pelvic fractures often require concurrent stabilization of the anterior and posterior pelvic rings. In addition, symphyseal plating leads to more blood loss when compared with INFIX [20]. This is because plating requires exposing the fracture site and the whole process of peeling of soft tissue and dissection around the area, which is rich in blood vessels and leads to greater intraoperative bleeding.…”