The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

Abstract

Purpose The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF). Methods Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated. Results Overall, three patients (8.3 %) died, and 31 patients (86 %) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97 %) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5 % of the patients, and a fair or poor for 35.5 %. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population. Conclusions The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future.

Midterm radiologic and functional outcomes of minimally-invasive fixation of unstable pelvic fractures using anterior internal fixator(INFIX) and percutaneous iliosacral screws

“…We ensured that the screw head remained above deep fascia to prevent compression of femoral nerve and inguinal ligament. We used 7mm-diameter polyaxial pedicle screws in comparison to that used by Vaidya 17,30,31,33 In contrast to previous studies, there were no cases of heterotopic ossification in our series at a mean follow-up of 34.9+/À4.1 months (Table 4). The incidence of this complication varies from 0 to 42% in previous studies.17 ,28,31,33 It is unclear why there were no cases of heterotopic ossification in our series.…”

“…[14][15][16] To overcome the complications of anterior external fixation, to improve patient comfort and facilitate early mobilization, several innovative techniques of minimally invasive anterior pelvic ring stabilization have been described in recent years. 17,[26][27][28][29][30][31][32][33][34] The "INFIX" is one such technique which utilizes the already established principles of external fixation. Biomechanical studies have shown that the INFIX has superior stability with respect to axial stiffness and stiffness at pubic symphysis, in the management of vertically and rotationally unstable pelvic ring injuries.…”

“…Majority of fractures in our series were AO/OTA type 61-C injuries, similar to three other studies. 17,30,33 In the largest series published by Vaidya et al, INFIX was used to treat lateral compression fractures, anteroposterior compression fractures, vertical shear or combined fracture patterns. 35 One main advantage of this procedure was the ease of nursing patients especially in the ICU setting due to the subcutaneous nature of the frame which facilitated easy patient mobilization and wound care.…”

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

“…Thirty-eight studies [ 8 , 9 , 25 , 26 , 28 – 30 , 32 – 36 , 10 , 37 – 44 , 46 , 47 , 11 , 48 – 54 , 56 , 18 – 22 , 24 ] used a pelvic-specific PROM, either as a single instrument or in combination with a generic PROM. Generic PROMs for physical functioning and quality of life were used in 15 studies [ 8 , 10 , 39 , 40 , 46 , 57 , 58 , 12 , 13 , 15 , 17 , 19 , 23 , 27 , 30 ]. The follow-up moment when these questionnaires were assessed ranged from six months to 15 years after the injury.…”

Beckenverletzungen aktuell: Die Rolle des Fixateurs bei Ringinstabilitäten

“…nachgewiesen werden[26], er bleibt jedoch der Symphysenplatte unterlegen. In einer klinischen Nachuntersuchung an 36 Patienten haben Müller et al[10] 65 % gute und sehr gute Ergeb-…”