Abstract
BackgroundThe subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture.MethodsA typical case is presented in this study. An 86-year-old woman suffered from an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation were selected to optimize surgical invasiveness and proper implant placement.ResultsThe patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon. Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer.ConclusionsThe technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.
Highlights
The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures
We describe a novel technique for treating pelvic ring fractures using the intraoperative computed tomography (CT) navigation system with an Internal pelvic fixator (INFIX)
We present a video about the INFIX technique with intraoperative CT navigation (Additional file 1: Video 1)
Summary
The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture. Orthopedic Trauma Association (AO/OTA) classification, are usually treated surgically. There are three types of internal fixation methods to be considered in the stabilization of pelvic ring fractures: anterior plate placement using an ilioinguinal approach; iliosacral (IS) screw fixation; and posterior lumbopelvic fixation using pedicle screw systems. A recent systematic review concluded that posterior pelvic internal fixation might yield better clinical results than nonoperative treatment and stabilization of the anterior pelvis [7]. Surgical exposure to posterior fixation is associated with a high wound complication rate. Severe wound complications such as skin necrosis may occur when patients are treated with transcatheter arterial embolization [8, 9]
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