A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures

Wayne Hoskins, Andrew Bucknill, James Wong, Edward Britton, Rodney Judson, Kellie Gumm, Roselyn Santos, Rohan Sheehy, Xavier Griffin, Wayne Hoskins, Andrew Bucknill, James Wong, Edward Britton, Rodney Judson, Kellie Gumm, Roselyn Santos, Rohan Sheehy, Xavier Griffin

Abstract

Background: External fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod.

Methods: A single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications.

Results: Twenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44-65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar.

Conclusions: Minimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised.

Trial registration: ACTRN12616001421426 . Registered 12 October 2016. Retrospectively registered.

Keywords: Bones; Fracture fixation; Fractures; Pelvis; Wounds and injuries.

References

    1. Hiesterman TG, Hill BW, Cole PA. A percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res. 2012;479:2116–2123. doi: 10.1007/s11999-012-2341-4.
    1. Gardner MJ, Nork SE. Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 2007;21:269–273. doi: 10.1097/BOT.0b013e318030e3e4.
    1. Riemer BL, Butterfield SL, Diamond DL, Young JC, Raves JJ, Cottington E, Kislan K. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma. 1993;35(5):671–675. doi: 10.1097/00005373-199311000-00003.
    1. Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36:599–604. doi: 10.1016/j.injury.2004.11.016.
    1. Vaidya R, Kubiak EN, Bergin PF, Dombroski DG, Critchlow RJ, Sethi A, Starr AJ. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012;470:2124–2131. doi: 10.1007/s11999-011-2233-z.
    1. Hupel T, McKee M, Waddell J, Schemitsch EH. Primary external fixation of rotationally unstable pelvic fractures in obese patients. J Trauma. 1998;45:111–115. doi: 10.1097/00005373-199807000-00024.
    1. Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma. 2012;26:1–8. doi: 10.1097/BOT.0b013e318233b8a7.
    1. Gardner MJ, Mehta S, Mirza A, Ricci WM. Anterior pelvic reduction and fixation using a subcutaneous internal fixator. J Orthop Trauma. 2012;26:314–321. doi: 10.1097/BOT.0b013e318220bb22.
    1. Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Onwudiwe NA, Vaidya R. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res. 2012;7:31. doi: 10.1186/1749-799X-7-31.
    1. Scheyerer MJ, Zimmermann SM, Osterhoff G, Tiziani S, Simmen HP, Wanner GA, Werner CML. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Research Notes. 2014;7:133. doi: 10.1186/1756-0500-7-133.
    1. Gabbe BJ, Esser M, Bucknill A, Russ MK, Hofstee DJ, Cameron PA, Handley C, de Steiger RN. The imaging and classification of severe pelvic ring fractures: experiences from two level 1 trauma centres. Bone Joint J. 2013;95-B(10):1396–1401. doi: 10.1302/0301-620X.95B10.32134.
    1. Owen MT, Tinkler B, Stewart R. Failure and salvage of “INFIX” instrumentation for pelvic ring disruption in a morbidly obese patient. J Orthop Trauma. 2013;27:e243–e246. doi: 10.1097/BOT.0b013e31828af6a4.
    1. Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS, Jr, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30:848–856. doi: 10.1097/00005373-199007000-00015.
    1. Hoppenfeld S, de Boer MA, Buckley R. Surgical exposures in orthopaedics: the anatomic approach. Philadelphia: Lippincott, Williams and Wilkins; 2009.
    1. Victorian State Trauma System. Available at . Department of Health and Human Services, State Government of Victoria, Australia. Last updated 22 May, 2014. Accessed 02 May 2015.
    1. Vavken P, Castellani L, Sculco TP. Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis. Clin Orthop Relat Res. 2009;467(12):3283–3289. doi: 10.1007/s11999-009-0924-5.
    1. Haidukewych GJ, Kumar S, Prpa B. Placement of half-pins for supra-acetabular external fixation: an anatomic study. Clin Orthop Relat Res. 2003;(411):269–73.
    1. Hagen J, Castillo R, Dubina A, Gaski G, Manson TT, O'Toole RV. Does surgical stabilization of lateral compression-type pelvic ring fractures decrease patients’ pain, reduce narcotic use, and improve mobilization? Clin Orthop Relat Res. 2016;474(6):1422–1429. doi: 10.1007/s11999-015-4525-1.

Source: PubMed

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