Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique

Wang, Qian; Wang, Qiugen; Wang, Jiandong

doi:10.1007/s00402-017-2701-3

Cited by 21 publications

(12 citation statements)

References 19 publications

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“…The anterior subcutaneous pelvic fixator (INFIX) has formerly been described as a treatment option for unstable pelvic ring fractures and biomechanical studies reveal a superior stability of the INFIX compared to a supraacetabular external fixator [6]. Clinical data show that the stability and the clinical outcome of patients with pelvic ring fracture treated with an INFIX (or INFIX with three screws) is sufficient compared to standard open plate osteosynthesis [7].…”

Section: Introductionmentioning

confidence: 99%

“…The configuration providing optimal stability when using the INFIX is debatable. A very limited number of papers demonstrated that it might be useful to add a third screw next to the pubic symphysis [7]. Another option to improve stability while reducing the risk of nerve damage on the contralateral side could be the connection between the unilateral supraacetabular screw with two screws on both side of the pubic symphysis.…”

Section: Introductionmentioning

confidence: 99%

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Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study

et al. 2019

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Background Operative procedures for unstable pelvic ring fractures remain controversially discussed. Minimally invasive treatment options for pelvic ring fractures have several benefits for the patient. But they can also provide disadvantages. Anterior subcutaneous pelvic fixation (INFIX) has shown promising biomechanical results in pelvic ring fractures, but there is a high complication rate of nerve injuries. An additional screw to the INFIX seems to be more stable. The aim of this study is to compare biomechanical stability of a new modified unilateral INFIX fixing the unilateral injured pelvic ring with the standard INFIX. Methods 24 composite synthetic full pelvises were used in this study. 4 groups each with a number of six pelvic specimens were randomly assigned. A C1.3-type pelvic fracture was made with an osteotomy of the sacrum and an osteotomy of the anterior pelvic ring. Fracture fixation was performed within the four groups: (1) unilateral INFIX, (2) “extended” unilateral INFIX + additional pubic ramus pedicle screw, (3) bilateral INFIX, (4) “extended” bilateral INFIX + additional pubic ramus pedicle screw. All specimens were cyclic loaded with 200 N until maximum of 300 N. Distance/dislocation of the fracture fragments were detected with 3D-ultrasound measuring system. Stiffness was calculated. Results Extended unilateral INFIX showed the lowest mean dislocation. Lowest rotational stability was displayed by the standard bilateral INFIX. A significant difference (P = 0.04) was shown between the extended unilateral INFIX and the “standard” bilateral INFIX in terms of rotational stability. Extended unilateral INFIX showed significantly improved stability of anterior fracture dislocation (P = 0.01) and unilateral INFIX showed the highest rotational stiffness. Anterior fixation stiffness of the unilateral INFIX was significantly improved using an additional symphysis/pubic ramus screw (P = 0.002). Conclusion Extended unilateral INFIX (+ additional pubic ramus pedicle screw) is a feasible minimally invasive treatment for anterior pelvic ring fractures. Higher stability and lower probability of bilateral nerve damage is provided by the extended unilateral INFIX compared to the standard bilateral INFIX.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study

et al. 2019

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“…INFIX refers to a series of internal fixators which can indirectly reduce and fix pelvic anterior ring injuries with the advantages of short operation time, less intraoperative bleeding, and low infection rates. [ 19 – 21 ] However, this fixation is not our preference because it only provides the same mechanical strength as an external fixator, which is not enough stability, [ 22 ] and has complications, such as an increased risk of lateral femoral cutaneous nerve injury, painful implant impingement, and femoral nerve palsy caused by connecting rod compression. [ 23 – 25 ] Comparisons of the fixation strength between the reconstruction plate and the cannulated screw are inconsistent in different mechanical studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Sun

Yan

Wang³

et al. 2020

Medicine

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The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation. We retrospectively reviewed 18 patients (aged 25–62, 34.2 ± 7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ± 3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed. The operation time ranged from 30 to 65 minutes (42.8 ± 18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ± 22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ± 4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ± 2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation. Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.

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“…Wang et al [16] compared INFIX to open reduction and internal fixation in Type B (Tile classification) pelvic fractures and found the INFIX superior in operation time, length of hospital stay as well as in clinical and radiological 6-month follow-up. However, no subjective questionnaires were given to the patient.…”

Section: Discussionmentioning

confidence: 99%

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

Steer

Balendra

Matthews

et al. 2019

SICOT-J

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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.

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Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique

Abstract: The use of ASIF/TPS with triple pedicle screws could be a reasonable option for the treatment of type B unstable pelvic fractures.

Cited by 21 publications

References 19 publications

Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study

Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

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

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