Pelvic Ring Stabilization Using Anterior Subcutaneous Internal Fixation in Bladder Exstrophy Repair

Abstract

Bladder exstrophy (BE) is a congenital condition involving malformation of the anterior abdominal wall leading to an extruded bladder and with an “open” bony pelvis deformity and symphysis pubis diastasis. Multiple surgical techniques have been described for correction of the bony pelvis deformity in classic bladder exstrophy. A common way to close the pelvis and assist with bladder closure uses bilateral double iliac osteotomies stabilized with external fixation. However, external fixators are cumbersome, unsightly, and have an increased risk for pin tract infection due to contaminants such as urine and feces. We describe an alternative to external fixation with the use of subcutaneous anterior pelvic internal fixator (INFIX), which typically is reserved for adult pelvic trauma and is an effective alternative for anterior pelvic ring stabilization in older bladder exstrophy patients. Key Concepts•External fixators in bladder exstrophy patients are cumbersome, unsightly, have an increased risk for pin tract infection, and are costly due to the complexity of the constructs to maintain the reduction.•INFIX is a novel fixation technique that is well tolerated and an effective alternative for anterior pelvic ring fixation and stabilization in older bladder exstrophy patients.•The methods also allow patients to sit upright, turnover from side to side, and lie in the prone position.