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

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

doi:10.1186/s13018-016-0468-9

Abstract

BackgroundExternal 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.MethodsA 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.ResultsTwenty-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.ConclusionsMinimally 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.

Highlights

External fixation is commonly used as a means of definitive fixation of pelvic fractures
We report a single-centre prospective case series of the outcomes and complications associated with the INFIX technique
Nineteen operations were performed for acute pelvic ring fractures and two for salvage procedures followed failed open reduction and internal fixation of anterior ring fractures

Summary

Introduction

External fixation is commonly used as a means of definitive fixation of pelvic fractures. 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. The INFIX or “Pelvic Bridge” is a new technique that that was initially developed for use in obese patients and uses the principles of external fixation [7] It involves insertion of supra-acetabular pedicle screws connected by a subcutaneous cobalt-chromium contoured rod. Hoskins et al Journal of Orthopaedic Surgery and Research (2016) 11:135 allow pelvic reduction manoeuvres and compression at the fracture site. Such principles make INFIX an attractive surgical treatment modality, for comminuted fractures of the anterior pelvic ring. Compared with internal fixation, it has less stability and stiffness [9]

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