Modified pedicle screw-rod fixation versus anterior pelvic external fixation for the management of anterior pelvic ring fractures: a comparative study

Abstract

BackgroundAnterior pelvic ring fracture, as high-energy trauma, needs to be effectively treated. The purpose of the current study was to evaluate the clinical applications of modified pedicle screw-rod fixation and anterior pelvic external fixation for the treatment of anterior pelvic ring fracture.MethodsEither modified pedicle screw-rod fixation (modified PSRF group, N = 21) or anterior pelvic external fixation (APEF group, N = 22) was performed to 43 patients, with or without fixation of posterior ring. Clinical outcomes were evaluated via Majeed scores. Relevant clinical evaluation indicators including operation time, intraoperative blood loss, hospitalization duration, and complications were compared between these two groups.ResultsThe operation time in APEF group was significantly less than that in modified PSRF group (P < 0.0001). No significant difference with respect to intraoperative blood loss and hospitalization duration between the two groups was shown (P = 0.51 and P = 0.33, respectively). Six patients developed surgical site infection in APEF group. Three patients experienced loss of fixation, and two patients experienced loosening of fixator in APEF group. Temporary lateral femoral cutaneous nerve irritation occurred in three patients in modified PSRF group while two patients in APEF group. One patient experienced femoral nerve palsy in modified PSRF group. Fractures of all patients healed well eventually. No statistical difference regarding Majeed evaluation scores was found between two groups.ConclusionsApplication of both modified PSRF and APEF could provide similar satisfactory clinical outcomes for anterior pelvic ring fracture. Modified PSRF, a minimally invasive technique with the advantages of internal fixation, could be performed as an alternative method for instable pelvic fractures.Trial registrationResearch Registry UIN: researchregistry2776.

Management of LC Type I (LC-1) Pelvic Injuries with Complete Sacral Fracture : Is there a Role for Solitary Anterior Fixation?

“…Meanwhile, there was also no signi cant difference between the xation pattern of the anterior ring (p>0.05). The biomechanical study indicated that the retrograde screw could provide the comparable stability to reconstruction plate [32], meanwhile, the latest comparative study showed that the modi ed pedicle screw-rod xation (in x) and anterior external xation could provide similar satisfactory clinical outcomes for anterior pelvic ring fracture [33]. Therefore, the selection of the implant for anterior ring xation did not affect the outcomes in LC-1 pelvic fractures.…”

Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases

“…Moreover, FN injury is one of the serious INFIX complications and manifests as numbness in the front of the thigh, weakness in the quadricep muscles, difficulty in walking, and weakness in knee extension [ 40 ]. Some patients gradually recovered after the removal of the INFIX or adjustment of the position in time [ 4 , 32 ]. However, there are some who experienced permanent FN injury and complained of muscle weakness and numbness at the last follow-up [ 30 , 40 ].…”

“…Approximately 50% of the patients have unstable pelvic ring fractures that are often accompanied by hemodynamic instability usually caused by high-energy injuries, which often damage the bone–ligament structures and then cause vertical or rotational instability of the pelvis [ 3 ]. Anterior ring provides 30–40% pelvic stability and posterior ring provides 60–70% pelvic stability [ 4 , 5 ]. Posterior fractures of unstable pelvic ring injuries often require operative fixation because conservative treatment often fails to achieve good outcomes [ 6 ].…”

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

“…An excellent reduction rate of 53.85% was obtained in this study through the Stoppa approach. One new modified technique has been proposed based on the INFIX system, which adds one or two pedicle screws into the pubic tubercle via an invasive incision 15 . This improvement was thought to be capable of restricting the movement of the pubis fragment and affords more stabilization.…”

“…It proved to be stiffer than the traditional external fixator, and at the same time eliminates the open pin tracts, which increased the infection rate and nursing care. INFIX was initially designed as an alternative to the external fixator, but recently its indications have been expanded and multiple complications have been reported 9–15 .…”