Abstract
ObjectivesThis study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using the Tornetta and Matta grading system and finite element analyses (FEA).MethodsIn a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n = 30) or INFIX (n = 33). The main outcome measures were the Majeed score, incidence of complications, and adverse outcomes, and fixation stability as evaluated by finite element analysis.ResultsSixty-three patients were included in the study, with an average age of 34.4 and 36.2 in modified group and conventional group, respectively. Two groups did not differ in terms of the injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a rate of higher satisfactory results according to the Tornetta and Matta grading system than the conventional group (73.33% vs 63.63%) as well as a higher Majeed score (81.5 ± 10.4 vs 76.3 ± 11.2), and these differences were statistically significant at 6 months post-surgery. FEA showed that MPSRF was stiffer and more stable than INFIX and had a lower risk of implant failure.ConclusionsBoth MPSRF and INFIX provide acceptable biomechanical stability for the treatment of unstable anterior pelvic ring fractures. However, MPSRF provides better fixation stability and a lower risk of implant failure, and can thus lead to better clinical outcomes. Therefore, MPSRF should be more widely applied to anterior pelvic ring fractures
Highlights
Anterior pelvic structures are more fragile and prone to fracture than dorsal structures as they bear higher loads [1]
The insertion of supraacetabular pedicle screws connected via a subcutaneous contoured rod tunneled just below the belly crease [8], which is known as the subcutaneous anterior pelvic fixation (INFIX) technique, has the advantages of convenience, minimal invasiveness and blood loss, and relatively little discomfort for patients with anterior pelvic ring injuries [9, 10]
We previously showed that modified pedicle screw-rod fixation (MPSRF) can lead to more rapid recovery from anterior pelvic ring fractures, and patients can obtain greater clinical outcome [12]
Summary
Anterior pelvic structures are more fragile and prone to fracture than dorsal structures as they bear higher loads [1]. External fixation and open reduction internal fixation (ORIF) are the primary modalities of treatment for trauma to the extremities and pelvis, which could provide a rapid and stiff fixed strength [3]. These methods are associated with complications such as pin tract infection (in 2–50%), fixation loosening (in 0–20%), loss of reduction (0–30%), and restriction of daily activities, in obese patients [4, 5]. Minimally invasive fixation methods are increasingly being used as an alternative to external fixation methods for the treatment of anterior pelvic ring fractures [6, 7]. The insertion of supraacetabular pedicle screws connected via a subcutaneous contoured rod tunneled just below the belly crease (the so-called bikini area) [8], which is known as the subcutaneous anterior pelvic fixation (INFIX) technique, has the advantages of convenience, minimal invasiveness and blood loss, and relatively little discomfort for patients with anterior pelvic ring injuries [9, 10]
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