Subcutaneous internal anterior fixation of pelvis fractures—which configuration of the InFix is clinically optimal?—a retrospective study

Scherer, Julian; Tiziani, Simon; Sprengel, Kai; Pape, Hans-Christian; Osterhoff, Georg

doi:10.1007/s00264-018-4110-9

Cited by 16 publications

(15 citation statements)

References 15 publications

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“…In a multicentre review, 30% (21/91) of patients had LFCN irritation although in most cases it was self-limiting and improved once the implant was removed [5]. In line with this study, in our investigation the rate of LFCN injury was 33.3% (10/30) [23]. We first locked the screws at bilateral AIIS so that the pullout strength of the screw was mainly concentrated in the supra-acetabular region, where bone density is high.…”

Section: Biomechanical Characteristics Of Intact Modelsupporting

confidence: 86%

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

Ding

Chen

Huang

et al. 2020

Preprint

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Objectives: This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures. Methods: In a retrospective review of a consecutive patient series conducted in a level 1 trauma university hospital, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n=30) or INFIX (n=33). The mean follow-up was 20 months. The main outcome measure was the incidence of complications and adverse outcomes, and fixation stability was evaluated by finite element analysis (FEA). Results: The 2 groups did not differ in terms of injury severity score, OTA classification, cause of injury, and time to pelvic surgery (P>0.05). However, the MPSRF group had a higher satisfactory rate according to the Tornetta and Matta grading system than the INFIX group (73.33% vs 63.63%) as well as a higher Majeed score (81.5±10.4 vs 76.3±11.2), which was statistically significant at 6 months’ post-surgery (P<0.001). FEA showed that MPRSF was stiffer and more stable than INFIX and had a lower risk of implant failure. Conclusions: Both MPSRF and INFIX have acceptable biomechanical stability for the treatment of unstable pelvic anterior ring fractures. However, MPRSF has better fixation stability and lower risk of implant failure, which can lead to better clinical outcomes.

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Section: Biomechanical Characteristics Of Intact Modelsupporting

confidence: 86%

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

Ding

Chen

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…We also only considered the ISD and did not account for the conical shape of the screw. The 1.5 cm spacing between the bone and head of the screw was an attempt to avoid compression of the femoral neurovascular bundle and opted for more conservative results considering a constant screw cross‐section. For future development of this study, an algorithm with the ability to evaluate all feasible trajectories for other angles should be further explored.…”

Section: Discussionmentioning

confidence: 99%

“…The screw length was considered as the sum of the intraosseous depth and 15 mm distance that has been suggested as minimal gap between the bone and screw head to avoid impingement with soft tissues . The ISD of 120 mm was selected to characterize the extreme combination of the longest documented screw length used for extremely obese patients, and largest bone to rod distance documented in literature of 25 mm . The screw core diameter of the template was set to 4 mm as representative to a screw size of 6.5 mm …”

Section: Methodsmentioning

confidence: 99%

“…When it is disclosed, it is not supported by a criteria for its determination at time of surgery . It is also highlighted that this technique has a learning curve associated with the depth placement of the screws and connecting rod and has only been described in cadaveric studies . Because, in existing literature there are no clear indications on how angulation and screw length should be determined at the time of surgery planning, we aimed to explore the narrowing ranges of safe insertion with increasing screw lengths and how these ranges are narrowed in the transverse and sagittal planes to reduce this learning curve for surgeons.…”

mentioning

confidence: 99%

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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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“…A case series of LFCN irritation suggested that screws that are too deeply or insu ciently embedded in the bone and inadequate prebending of the rod can lead to irritation of the LFCN and sartorius muscle. To prevent this, a rod-to-bone distance of 20-25 mm (30-40 mm for obese patients) but <40 mm is recommended [23]. We rst locked the screws at bilateral AIIS so that the pullout strength of the screw was mainly concentrated in the supraacetabular region, where bone density is high.…”

Section: Risk Of Implant Failure and Micromotion In The Injury Modelmentioning

confidence: 99%

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

Ding

Chen

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

Objectives: This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using Tornetta and Matta grading system and finite element analyses.Methods: In a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n=30) or INFIX (n=33). The main outcome measure were Majeed score, incidence of complications and adverse outcomes, and fixation stability was evaluated by finite element analysis (FEA).Results: two groups did not differ in terms of injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a higher satisfactory rate according to the Tornetta and Matta grading system than the INFIX group (73.33% vs 63.63%) as well as a higher Majeed score (81.5±10.4 vs 76.3±11.2), which was statistically significant at 6 months’ post-surgery. FEA showed that MPRSF was stiffer and more stable than INFIX and had a lower risk of implant failure.Conclusions: Both MPSRF and INFIX have acceptable biomechanical stability for the treatment of unstable pelvic anterior ring fractures. However, MPRSF has better fixation stability and lower risk of implant failure, which can lead to better clinical outcomes.

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Subcutaneous internal anterior fixation of pelvis fractures—which configuration of the InFix is clinically optimal?—a retrospective study

Abstract: Planned optimized configuration of the InFix with a rod-to-bone distance between 20 and 25 mm may reduce postoperative complications. Regarding LFCN damage, the rod-to-symphysis distance should not be more than 40 mm.

Cited by 16 publications

References 15 publications

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

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