Lateral Femoral Cutaneous Nerve Irritation Research Articles

A nerve-to-implant distance as a novel predictor for lateral femoral cutaneous nerve injuries after anterior subcutaneous pelvic internal fixation.

Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common complication. This study aimed to investigate the association between the nerve-to-implant distance and the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and ≥13 mm. The proportion of patients who experienced postoperative nerve disorders was compared using the nerve status. Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the other three occurred in patients whose nerves were not identified. A nerve-to-implant distance ≥13 mm was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve-to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance ≥13 mm had a perfect sensitivity (100%) and modest specificity (58.3%). Nerve-to-implant distance was ≥13 mm. Nerve disorders were frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal fixation-related nerve disorders.

PUBIC SYMPHYSIS DIASTASIS TREATED WITH ANTERIOR SUBCUTANEOUS INTERNAL PELVIC FIXATOR A CASE REPORT

This is a new method of treatment for Pubic Symphysis diastasis with anterior subcutaneous pelvic internal fixation (later called as INFIX) using pedicle screws and a spinal rod. Pedicle screw and Spinal rod was used to address shortcomings of external fixation (EXFIX).Pedicle screws were passed into AIIS through small incision. Contoured Spinal rod of suitable length passed across the lower abdominal wall in subcutaneous plane, compression achieved manually and rod connected to screws and tightened. Patient is able to tolerate implants and is able to sit, stand and walk without difficulty. Complications include lateral femoral cutaneous nerve irritation, which resolved after 5weeks. Appearance of INFIX provides a new alternative treatment; INFIX is minimally invasive and time-saving for treatment of anterior pelvic ring injuries. The EXFIX is an effective tool for anterior ring fixation and has been widely used. However, it is associated with many complications such as pin-track infection, aseptic loosening and loss of reduction. INFIX is less disabling for treatment of Pubic Symphysis Diastasis.

Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases

BackgroundThis study aimed to evaluate the radiographic and clinical outcomes of anterior subcutaneous internal fixation (INFIX) with or without posterior fixation for the treatment of unstable pelvic fractures.MethodsIntraoperative blood loss, operation time, and duration of hospital stay were recorded, and fracture union and postoperative complications were evaluated. The fracture reduction quality was evaluated using the Matta score, pelvic deformity index (PDI), and pubic symphyseal width (PSW). In addition, the functional recovery and general quality of life were evaluated using the Majeed score and the 12-Item Short-Form Survey (SF-12), respectively. Furthermore, sacral nerve injury was evaluated using the Gibbons classification.ResultsTwenty-seven patients (14 males and 13 females) with an average age of 37.4 years were followed up for a mean of 22 months. The average operation time, median intraoperative blood loss, and average duration of hospital stay were 129 ± 47 min, 100 mL, and 22 ± 13 days, respectively. All patients achieved bony union with an average union time of 13.3 weeks. Furthermore, the average PDI and PSW were 0.07 ± 0.04 vs. 0.04 ± 0.03 (P = 0.009) and 1.15 ± 1.36 vs. 0.54 ± 0.17 (P = 0.048) before and after the operation, respectively. In 78% of the patients, the Matta or Majeed scores were excellent or good. The SF-12 physical and mental health scores were 45.1 ± 10.2 and 53.2 ± 6.3, respectively. Furthermore, one superficial surgical site infection, one loosening of INFIX, one lateral femoral cutaneous nerve irritation, one femoral nerve injury, and two implant discomforts due to the bar were noted. Among five patients with sacral nerve injuries, four were asymptomatic, and one just had paresthesia at the last follow-up.ConclusionINFIX with or without sacroiliac screws can achieve satisfactory radiographic and functional outcomes in the treatment of unstable pelvic ring fractures.Trial registrationChiCTR2000038812. Registered 04 October 2020. Retrospectively registered.

Complications following minimally invasive internal fixation for anterior pelvic ring injury: a Meta-analysis

Objective To summarize the complications and their incidences following Anterior Sub-cutaneous Internal Pelvic Fixation(ASIPF). Methods A comprehensive search was conducted of PubMed Library, Cochrane Library, Web of Science, SinoMed, Wanfang Data and China National Knowledge Internet for all articles addressing the postoperative complications of ASIPF published in English and Chinese from January 2009 to November 2018. A proportion Meta-analysis across the studies was performed for the complications after ASIPF (lateral femoral cutaneous nerve irritation, femoral nerve palsy, heterotopic ossification, infection and implant failure) using R software. Results This meta-analysis included 29 clinical studies involving a total of 825 patients. The complications following ASIPF were lateral femoral cutaneous nerve irritation, femoral nerve palsy, heterotopic ossification, infection and implant failure; their incidences were respectively 12% (95%CI: from 7% to 19%), 3% (95%CI: from 2% to 4%), 30% (95%CI: from 22% to 39%), 4% (95%CI: from 3% to 6%) and 4% (95%CI: from 3% to 6%). Conclusions Lateral femoral cutaneous nerve irritation and heterotopic ossification are common complications following minimally invasive internal fixation for anterior pelvic ring injury. High-quality clinical research is needed into the factors leading to the complications and into their preventive countermeasures. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Surgical procedures, minimally invasive; Complications

Anterior Subcutaneous Internal Pelvic Fixation/INFIX: A Systemic Review.

The purpose of this article is to review the available literature on anterior subcutaneous internal pelvic fixation (ASIPF) to identify indications, clinical and radiographic outcomes, and compare these with alternative fixation methods. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search on PubMed and Google Scholar was performed. Articles included were in the English language or English translations and published between 2007 and 2018. Studies included were appraised with narrative data synthesis. Twenty-five articles with 496 patients were included. These included 17 case series, with 3 case reports reporting adverse events. ASIPF and the appropriate posterior fixation resulted in healing of pelvic ring injuries in 99.5% of cases. Indications include unstable pelvic ring injuries with the appropriate posterior fixation. Radiographic parameters and outcome measures were infrequently reported. ASIPF is a valuable tool for reduction and fixation in unstable pelvic ring injuries. Complications include lateral femoral cutaneous nerve irritation (26.3%); heterotopic ossification (36%); infection (3%); and femoral nerve palsy (1%), which is likely related to placing the bar and screws too deep.

Modified pedicle screw-rod fixation versus anterior pelvic external fixation for the management of anterior pelvic ring fractures: a comparative study

BackgroundAnterior pelvic ring fracture, as high-energy trauma, needs to be effectively treated. The purpose of the current study was to evaluate the clinical applications of modified pedicle screw-rod fixation and anterior pelvic external fixation for the treatment of anterior pelvic ring fracture.MethodsEither modified pedicle screw-rod fixation (modified PSRF group, N = 21) or anterior pelvic external fixation (APEF group, N = 22) was performed to 43 patients, with or without fixation of posterior ring. Clinical outcomes were evaluated via Majeed scores. Relevant clinical evaluation indicators including operation time, intraoperative blood loss, hospitalization duration, and complications were compared between these two groups.ResultsThe operation time in APEF group was significantly less than that in modified PSRF group (P < 0.0001). No significant difference with respect to intraoperative blood loss and hospitalization duration between the two groups was shown (P = 0.51 and P = 0.33, respectively). Six patients developed surgical site infection in APEF group. Three patients experienced loss of fixation, and two patients experienced loosening of fixator in APEF group. Temporary lateral femoral cutaneous nerve irritation occurred in three patients in modified PSRF group while two patients in APEF group. One patient experienced femoral nerve palsy in modified PSRF group. Fractures of all patients healed well eventually. No statistical difference regarding Majeed evaluation scores was found between two groups.ConclusionsApplication of both modified PSRF and APEF could provide similar satisfactory clinical outcomes for anterior pelvic ring fracture. Modified PSRF, a minimally invasive technique with the advantages of internal fixation, could be performed as an alternative method for instable pelvic fractures.Trial registrationResearch Registry UIN: researchregistry2776.

Midterm radiologic and functional outcomes of minimally-invasive fixation of unstable pelvic fractures using anterior internal fixator(INFIX) and percutaneous iliosacral screws.

Anterior pelvic external fixation is associated with pin site infections, aseptic loosening with loss of reduction, frame bulkiness hindering patient mobilization and consequent difficulties in inpatient nursing. We performed a single-center prospective series to evaluate the feasibility, safety, limitations and midterm radiologic and functional outcomes of an alternative minimally invasive pelvic internal fixation technique using an anterior subcutaneous pelvic internal fixator (INFIX) and percutaneous iliosacral screws in unstable pelvic ring fractures. Fifteen consecutive patients with vertically and/or rotationally unstable pelvic fractures, presenting to a Level-1 trauma center were treated with closed reduction, appropriate posterior stabilization with percutaneous iliosacral screws and anterior INFIX application. Outcomes were analyzed with respect to the quality of fracture reduction (Matta's radiologic criteria), ease of inpatient nursing, patient mobility and comfort, functional outcomes at final follow-up (Majeed score, SF-12 score), social reintegration and complications. Most common injury pattern was AO/OTA type 61-C pelvic fracture in thirteen patients. Mean procedure time and intra-operative blood loss were, 57.1+/-4.9min (range,51-68min) and 115.3+/-26.7ml (range,80-170ml) respectively. Mean follow-up was 34.9+/-4.1 months (range,31-42 months). Fracture reduction was excellent in twelve and good in three patients (Matta's criteria). Functional outcomes were excellent in eight and good in seven patients (Majeed score). Mean SF-12 scores for physical and mental health were 48.58+/-5.61 and 50.89+/-3.97 respectively. Thirteen patients returned to their pre-injury jobs. All fifteen patients reintegrated into society without any restrictions. INFIX was removed at a mean post-operative period of 7.3+/-1.5 months (range,5.5-11 months). Complications included, lateral femoral cutaneous nerve irritation(n=1), superficial wound infection(n=1) and loss of reduction(n=2). Minimally invasive pelvic stabilization using INFIX and percutaneous iliosacral screws is easy to learn and apply, achieves good fracture reduction and definitive stabilization with minimum complications and offers excellent functional outcomes at a minimum follow-up of 31 months. Level IV.

Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries.

To describe our experience using the anterior internal pelvic fixator (INFIX) for treating pelvic ring injuries. Case Series. Level 1 Trauma Center. Eighty-three patients with pelvic ring injuries were treated with INFIX. Follow-up average was 35 months (range 12-80.33). Surgical treatment of pelvic ring injuries included reduction, appropriate posterior fixation, and INFIX placement. Reduction using the pelvic deformity index and pubic symphysis widening, Majeed functional scores, complications; infection, implant failure, heterotopic ossification (HO), nerve injury, and pain. All patients healed in an appropriate time frame (full weight bearing 12 weeks postoperation). The average pelvic deformity index reduction (injury = 0.0420 ± 0.0412, latest FU = 0.0254 ± 0.0243) was 39.58%. The average reduction of pubic symphysis injuries was 56.92%. The average Majeed score of patients at latest follow-up was 78.77 (range 47-100). Complications were 3 infections, 1 case of implant failure, 2 cases implantation too deep, 7 cases of lateral femoral cutaneous nerve irritation, and 3 cases of pain associated with the device. HO was seen in >50% of the patients, correlated with increased age (P < 0.007), injury severity score (P < 0.05) but only 1 case was symptomatic. The pelvic injuries had good functional and radiological outcomes with INFIX and the appropriate posterior fixation. The downside is removal requiring a second anesthetic, there is a learning curve, HO often occurs, the lateral femoral cutaneous nerve may get irritated which often resolves once the implants are removed. Surgery-specific implants need to be developed. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Anterior Subcutaneous Pelvic Fixator (INFIX) in an Anterior Posterior Compression Type 3 Pelvic Fracture

The purpose of this video is to describe the equipment, anatomy, and surgical technique of anterior subcutaneous pelvic fixation (INFIX) using pedicle screws and a rod in an Anterior Posterior Compression 3 pelvic fracture, as well as how to distract in lateral compression fractures. The equipment required includes standard spine pedicle screw sets with long screws, 70-110 mm in length, and 7 or 8 mm in diameter. The approach is a mini open and one needs to be familiar with the iliac oblique, obturator outlet, and obturator inlet views. The length of the screw is measured from the sciatic notch to the skin, and they are placed so that the head sits just below the skin. The rod is passed just under the skin along the bikini line and the construct compressed or distracted against a c-clamp while monitored with fluoroscopy. In Orthopaedic Trauma Association C type injuries, we leave c-clamps on the outside the screws to reinforce them or use monoaxial screws. The implants are removed at 3-6 months postop. The patients tolerate the implants and are able to sit and stand with out difficulty. Complications include lateral femoral cutaneous nerve irritation, heterotopic bone, loss of fixation if the implants are applied incorrectly. The INFIX procedure for anterior pelvic fixation is based on standard techniques that are familiar to the Orthopaedic Pelvic Surgeon including supraacetabular screws. Rod bending, rod passing, determining the ideal height of the screws, and distraction/compression maneuvers are demonstrated in this video.