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

Richard Steer, Ganesh Balendra, Justin Matthews, Martin Wullschleger, James Reidy, Richard Steer, Ganesh Balendra, Justin Matthews, Martin Wullschleger, James Reidy

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.

© The Authors, published by EDP Sciences, 2019.

Figures

Figure 1
Figure 1
Initial imaging of a combined mechanism pelvis injury.
Figure 1
Figure 1
Initial imaging of a combined mechanism pelvis injury.
Figure 2
Figure 2
Day 1 post pelvis fixation: trans-sacral S1 and S2 screws with INFIX.
Figure 2
Figure 2
Day 1 post pelvis fixation: trans-sacral S1 and S2 screws with INFIX.
Figure 3
Figure 3
After removal of INFIX and anterior union.
Figure 3
Figure 3
After removal of INFIX and anterior union.
Figure 4
Figure 4
Metalware failure: device locking mechanism failure.
Figure 4
Figure 4
Metalware failure: device locking mechanism failure.
Figure 5
Figure 5
Straddle type fracture-bilateral public rami fractures with bilateral sacral fractures. Initial radiograph on arrival with binder on.
Figure 5
Figure 5
Straddle type fracture-bilateral public rami fractures with bilateral sacral fractures. Initial radiograph on arrival with binder on.
Figure 6
Figure 6
CT 3D reconstruction of Figure 5 injury.
Figure 6
Figure 6
CT 3D reconstruction of Figure 5 injury.
Figure 7
Figure 7
Day 1 after fixation. Bilateral sacroiliac joint screws with INFIX. Filters in both common iliac veins. AP image.
Figure 7
Figure 7
Day 1 after fixation. Bilateral sacroiliac joint screws with INFIX. Filters in both common iliac veins. AP image.
Figure 8
Figure 8
Day 1 after fixation. Bilateral sacroiliac joint screws with INFIX. Inlet image.
Figure 8
Figure 8
Day 1 after fixation. Bilateral sacroiliac joint screws with INFIX. Inlet image.
Figure 9
Figure 9
Day 1 after fixation. Bilateral sacroiliac joint screws with INFIX. Outlet view.
Figure 9
Figure 9
Day 1 after fixation. Bilateral sacroiliac joint screws with INFIX. Outlet view.
Figure 10
Figure 10
After union and removal of INFIX. Mild right-sided heterotopic ossification noted. AP image.
Figure 10
Figure 10
After union and removal of INFIX. Mild right-sided heterotopic ossification noted. AP image.
Figure 11
Figure 11
After union and removal of INFIX. Mild right-sided heterotopic ossification noted. Inlet image.
Figure 11
Figure 11
After union and removal of INFIX. Mild right-sided heterotopic ossification noted. Inlet image.
Figure 12
Figure 12
After union and removal of INFIX. Mild right-sided heterotopic ossification noted. Outlet image.
Figure 12
Figure 12
After union and removal of INFIX. Mild right-sided heterotopic ossification noted. Outlet image.

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