The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes

Abstract

Purpose: Pelvic anterior internal fixators (INFIX) are a relatively new alternative in the treatment of unstable pelvic fractures. The authors wanted to review the use of complications and outcomes of this method of pelvic fixation at our institution. Method: Patients over the age of 18 who had an INFIX used in treatment of their pelvic ring injury were identified. Patient demographics, fracture type, injury severity score, morbidity, complications and time until removal were recorded. All available patients were followed up following the removal of the INFIX and completed an Iowa Pelvic Score (IPS) at this time. Results and Discussion: 24 patients (19 male) with a mean age of 38.5 (range 18–71) met the inclusion criteria with an average injury severity score of 29.8 (10–66). The most common complication following insertion was a lateral femoral cutaneous nerve (LFCN) injury, which occurred in 11 patients (bilaterally in two), 6 patients (25%) had ongoing numbness 6 months post removal. Two patients had an infection, one of which prompted the removal of the INFIX. One INFIX was removed for implant failure. All other removals were planned electively. Heterotopic ossification was noted to have occurred in five cases. The mean IPS following removal of the INFIX was 79.2 (52–100). INFIX is a safe and successful treatment for unstable pelvic ring injuries. Overall, patients tolerate the INFIX well with good outcome scores. The main concern being the high rate of LFCN injuries, although many resolved after removal of the INFIX.

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

“…There were some common complications related to surgical operation, such as implant loosening, pin tract infection, aseptic loosening, the incidence of which for INFIX was very low compared with that for EXFIX [ 28 ]. Failure in INFIX implant only occurred in 0–13% patients [ 6 , 27 , 34 ] and wound problems (e.g., fat liquefaction, incision dehiscence, epidermal infection, and deep infection) only occurred in 0–8% patients [ 14 , 34 , 35 ].…”

“…Failure in INFIX implant only occurred in 0–13% patients [ 6 , 27 , 34 ] and wound problems (e.g., fat liquefaction, incision dehiscence, epidermal infection, and deep infection) only occurred in 0–8% patients [ 14 , 34 , 35 ].…”

Results of minimally invasive quick definitive fixation of unstable bony pelvic disruption by combined retrosacral transiliac rods and anterior external fixator during a critical national period

“…It is also associated with injury to the lateral femoral cutaneous nerve (LFCN) in 30% of patients and femoral nerve palsies due to impingement of the bar on psoas sheath causing delayed femoral palsy due to psoas engorgement with blood in the standing position. [9][10][11][12][13] In our study, we used Hoffman external fixator for its availability, low cost, easiness of application, proved rigidity and its easy removal as an outpatient procedure. We had 3 cases (18.7%) of pin tract infection with iliac fixators but no cases of LFCN injury with supra-acetabular fixator.…”

An overview of the key principles and guidelines in the management of pelvic fractures

“…This approach also gives the urologist adequate exposure to address any co-existing bladder injuries (Wu et al 2015). Alternatively, anterior fixation may be achieved percutaneously in selected cases using an anterior subcutaneous internal pelvic Fixator (INFIX) (Steer et al 2019). External fixation is usually used as a temporary measure before internal fixation can be arranged; however, it may also be used as a definitive treatment for unstable APC fractures accompanied by extraperitoneal bladder rupture, or in contaminated open pelvic fractures (Langford et al 2013b).…”