Abstract
BackgroundOperative 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.Methods24 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.ResultsExtended 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).ConclusionExtended 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.
Highlights
While consensus exists on the need of surgical treatment of unstable pelvic ring fractures, the choice of the ideal strategy for osteosynthesis remains controversial [1,2,3]
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 is sufficient compared to standard open plate osteosynthesis [7]
Summary
While consensus exists on the need of surgical treatment of unstable pelvic ring fractures, the choice of the ideal strategy for osteosynthesis remains controversial [1,2,3]. 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]. Some clinical data hints towards increased complication rates for the INFIX as well as supraacetabular external fixation, the main complication being damage to the superficial femoral cutaneous nerve [8, 9]. This nerve is at risk on both sides of the pelvic ring as it is situated closely to the lateral screw and it can be crushed between the bone cortex and the rod.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
