Treatment of Unstable Pelvic Ring Injuries With an Internal Anterior Fixator and Posterior Fixation: Initial Clinical Series

Vaidya, Rahul; Colen, Robert; Vigdorchik, Jonathan M.; Tonnos, Fredrick; Sethi, Anil

doi:10.1097/bot.0b013e318233b8a7

Cited by 160 publications

(169 citation statements)

References 6 publications

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“…The first report on its technology, application, and on the initial clinical results was published in 2009 [15]. In the meantime, similar or slightly modified publications from other authors have become available [14,16]. The objective of this retrospective evaluation of cases was the initial collection of mid-to long-term clinical and radiological data.…”

Section: Introductionmentioning

confidence: 99%

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

Müller

Stosiek

Zellner

et al. 2013

International Orthopaedics (SICOT)

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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.

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Section: Introductionmentioning

confidence: 99%

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

Müller

Stosiek

Zellner

et al. 2013

International Orthopaedics (SICOT)

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“…The technique is relatively atraumatic and is mostly minimally invasive. The anterior abdominal rod used in our construct has been used successfully to treat unstable pelvic fractures in a case series of 17 cases, with only two cases of reported transient femoral cutaneous nerve palsy [17]. The blood loss in our case was negligible.…”

Section: Rationale Of Treatment and Evidence-based Literaturementioning

confidence: 73%

A novel “pelvic ring augmentation construct” for lumbo-pelvic reconstruction in tumour surgery

et al. 2012

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Aim Reconstructing or augmenting the lumbo-pelvic junction after resection of L5 and part of the sacrum is challenging. Numerous lumbo-pelvic reconstruction methods based on posterior construct and anterior cages have been proposed for cases involving total sacrectomy and lumbar vertebrectomy. These constructs create long lever arms and generate high cantilever forces across the lumbo-sacral junction, resulting in implant failure or breakage. Biomechanical studies have shown that placing implants anterior to lumbo-sacral pivot point provides a more effective moment arm to resist flexion force and improves the ultimate strength of the construct. We present here a novel method to augment a lumbo-pelvic construction using a pelvic ring construct. Methods A 69-year-old lady presented with implant failure of her two previous posterior lumbo-pelvic reconstructions performed by the authors. She initially presented, two and a half years previously with 6 months history of back pain with normal neurological function. MRI scans of her whole spine showed isolated secondaries in the lumbar spine (L4, L5) and sacrum (S1). An abdominal CT scan revealed a primary tumour in her right kidney. Briefly, the first surgery involved a single-stage removal of posterior elements of L4 and L5 and posterior stabilisation from L2 to pelvis, anterior resection of L4 and L5 and partially S1 with implantation of an expandable Synex II cage. The cage was replaced with an anterior rod construct from L2 and L3 to a trans-sacral screw a week later as it had dislodged. The second revision, 9 months later, involved removal of two posterior broken rods which were replaced and converted into a modified four-rod construct. While monitoring her progress, it was subsequently noted that the trans-sacral rod had broken. Therefore, it was decided to augment her lumbo-pelvic construct to prevent eventual catastrophic posterior construct failure. From a posterior approach, contoured rods were passed bilaterally along the inner table of the pelvis under the iliacus muscle up to the anterior border of the pelvis. Using T-connectors, the rods were connected to the posterior lumbo-pelvic construct. Thereafter, two anterior supra-acetabular pelvic screws were connected to a subcutaneously placed rod matched to the shape of the anterior abdominal wall. The pelvic ring construct was completed on connecting this rod with T-connectors to the free ends of the contoured iliac rods.

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“…First, the hardware is placed entirely under the skin; therefore, the surgical wounds are closed primarily. Second, there is no or minimal hardware prominence, in contradistinction to an external fixator, and fewer difficulties with clothing wear, sitting in a chair, sexual intercourse, skin impingement, and surgical site pain [13,31]. Other drawbacks to external fixation include pin tract infections, fixator loosening, limited surgical access to the abdomen, and reoperations [14,15,17,23,24,30].…”

Section: Discussionmentioning

confidence: 99%

“…The LFCN palsy likely occurred during placement or removal of hardware in the supraacetabular region where the nerve is at greater risk for injury [4,5,9]. Two studies from the United States using the same technique as Kuttner et al [13] were recently published using spinal rods and pedicle screws placed in the anterior inferior iliac spines (AIIS) [6,31]. Both reported two patients with neuropraxias and complications with the subcutaneous fixator causing discomfort at the abdominal crease.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

Hiesterman

Hill

Cole

2012

Clinical Orthopaedics &Amp; Related Research

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Background Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis. Description of Technique An incision is made over each anterior iliac crest and a 6-to 8-cm incision is centered over the symphysis. Either a locking reconstruction plate or a spinal rod is placed through a subcutaneous tunnel overlying the external oblique fascia in the subcutaneous tissue, and fixation into the iliac crest and pubis is achieved to effect stability. Methods A randomized controlled trial comparing anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) for unstable pelvic ring injuries was begun in October 2010. Patients with unstable pelvic ring injuries were enrolled and followed with respect to fracture reduction, surgical pain, complications, and functional outcome scores.

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Treatment of Unstable Pelvic Ring Injuries With an Internal Anterior Fixator and Posterior Fixation: Initial Clinical Series

Cited by 160 publications

References 6 publications

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

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

A novel “pelvic ring augmentation construct” for lumbo-pelvic reconstruction in tumour surgery

Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

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