The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes.

Richard Steer,Justin Matthews,Ganesh Balendra,Martin Wullschleger,James Reidy

doi:10.1051/sicotj/2019019

Richard Steer, Justin Matthews + Show 3 more

Open Access

https://doi.org/10.1051/sicotj/2019019

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Abstract

Purpose: Pelvic anterior internal fixators (INFIX) are a relatively new alternative in the treatment of unstable pelvic fractures. The authors wanted to review the use of complications and outcomes of this method of pelvic fixation at our institution.Method: Patients over the age of 18 who had an INFIX used in treatment of their pelvic ring injury were identified. Patient demographics, fracture type, injury severity score, morbidity, complications and time until removal were recorded. All available patients were followed up following the removal of the INFIX and completed an Iowa Pelvic Score (IPS) at this time.Results and Discussion: 24 patients (19 male) with a mean age of 38.5 (range 18–71) met the inclusion criteria with an average injury severity score of 29.8 (10–66). The most common complication following insertion was a lateral femoral cutaneous nerve (LFCN) injury, which occurred in 11 patients (bilaterally in two), 6 patients (25%) had ongoing numbness 6 months post removal. Two patients had an infection, one of which prompted the removal of the INFIX. One INFIX was removed for implant failure. All other removals were planned electively. Heterotopic ossification was noted to have occurred in five cases. The mean IPS following removal of the INFIX was 79.2 (52–100). INFIX is a safe and successful treatment for unstable pelvic ring injuries. Overall, patients tolerate the INFIX well with good outcome scores. The main concern being the high rate of LFCN injuries, although many resolved after removal of the INFIX.

Highlights

Pelvic fractures are common presentations to major trauma centres and are associated with significant morbidity in polytrauma patients
The operations were performed by surgeons of varying levels of experience including an orthopaedic pelvic trauma surgeon, a general trauma surgeon, a general orthopaedic surgeon and senior orthopaedic registrars under supervision of the pelvic trauma surgeon
This study adds to the body of literature currently available on the use of an internal fixator (INFIX) in the management of unstable anterior pelvic ring trauma

Summary

Introduction

Pelvic fractures are common presentations to major trauma centres and are associated with significant morbidity in polytrauma patients. They are usually the result of high energy mechanisms such as road traffic accidents or falls from height, or the result of low energy trauma in osteoporotic bone in the elderly population. Traditional open reduction and internal fixation is associated with a high incidence of surgical morbidity, while external fixators, used for both temporary stabilisation and as definitive management, have a complication rate of up to 62% [4], with. The application of a pelvic internal fixator (INFIX) has been presented as a comparable alternative to external fixation of anterior pelvic ring injuries [7, 8].

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