Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study.

Detroit Medical Center, Wayne State University, 4D-4 University Health Center, Detroit Receiving Hospital, Detroit, MI 48201, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 01/2012; 470(8):2124-31. DOI: 10.1007/s11999-011-2233-z
Source: PubMed

ABSTRACT Stabilization after a pelvic fracture can be accomplished with an anterior external fixator. These devices are uncomfortable for patients and are at risk for infection and loosening, especially in obese patients. As an alternative, we recently developed an anterior subcutaneous pelvic internal fixation technique (ASPIF).
We asked if the ASPIF (1) allows for definitive anterior pelvic stabilization of unstable pelvic injuries; (2) is well tolerated by patients for mobility and comfort; and (3) has an acceptable complication rate.
We retrospectively reviewed 91 patients who incurred an unstable pelvic injury treated with an anterior internal fixator and posterior fixation at four Level I trauma centers. We assessed (1) healing by callous formation on radiographs and the ability to weightbear comfortably; (2) patient function by their ability to sit, stand, lie on their sides, and how well they tolerated the implants; and (3) complications during the observation period. The minimum followup was 6 months (mean, 15 months; range, 6-40 months).
All 91 patients were able to sit, stand, and lie on their sides. Injuries healed without loss of reduction in 89 of 91 patients. Complications included six early revisions resulting from technical error and three infections. Irritation of the lateral femoral cutaneous nerve was reported in 27 of 91 patients and resolved in all but one. Heterotopic ossification around the implants, which was asymptomatic in all cases, occurred in 32 of 91 patients.
The anterior internal fixator provided high rates of union for the anterior injury in unstable pelvic fractures. Patients were able to sit, stand and ambulate without difficulty. Infections and aseptic loosening were reduced but heterotopic ossification and irritation of the LFCN are common.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pelvic fractures in the geriatric population are increasing in incidence. Those resulting from high-energy trauma result in increased mortality rates and can be challenging to manage due to polypharmacy and multiple patient comorbidities. Low energy pelvic fractures can be difficult to diagnose and exceptionally painful for patients. Injury to the posterior pelvis guides management. All patients with fragility fractures should be evaluated for osteoporosis and managed according to established guidelines.
    06/2014; 3(2):101-108. DOI:10.1007/s13670-014-0082-9
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the mechanical properties of internal anterior fixators (known as INFIX), which have been proposed as subcutaneous alternatives to traditional anterior external fixators for pelvic ring disruptions. We hypothesised that INFIX has superior biomechanical performance compared with traditional external fixators because the distance from the bar to the bone is reduced. Using a commercially available synthetic bone model, 15 unstable pelvic ring injuries were simulated by excising the pubic bone through the bilateral superior and inferior rami anteriorly and the sacrum through the bilateral sacral foramen posteriorly. Three test groups were established: (1) traditional supra-acetabular external fixation, (2) INFIX with polyaxial screws, (3) INFIX with monaxial screws. Load was applied, simulating lateral compression force. Outcome measure was construct stiffness. The traditional external fixator constructs had an average stiffness of 6.21N/mm±0.40standard deviation (SD). INFIX with monaxial screws was 23% stiffer than the traditional external fixator (mean stiffness, 7.66N/mm±0.86SD; p=.01). INFIX with polyaxial screws was 26% less stiff than INFIX with monaxial screws (mean stiffness, 5.69N/mm±1.24SD; p=.05). No significant difference was noted between polyaxial INFIX and external fixators (mean stiffness, 6.21N/mm±0.40SD; p=.65). The performance of INFIX depends on the type of screw used, with monaxial screws providing significantly more stiffness than polyaxial screws. Despite the mechanical advantage of being closer to the bone, polyaxial INFIX was not stiffer than traditional external fixation. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 01/2015; 20. DOI:10.1016/j.injury.2015.01.040 · 2.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose This study investigates the biomechanical stability of a novel technique for symphyseal internal rod fixation (SYMFIX) using a multiaxial spinal screw-rod implant that allows for direct reduction and can be performed percutaneously and compares it to standard internal plate fixation of the symphysis. Methods Standard plate fixation (PLATE, n = 6) and the SYMFIX (n = 6) were tested on pelvic composite models with a simulated open book injury using a universal testing machine. On a previously described testing setup, 500 consecutive cyclic loadings were applied with sinusoidal resulting forces of 200 N. Displacement under loading was measured using an optoelectronic camera system and construct rigidity was calculated as a function of load and displacement. Results The rigidity of the PLATE construct was 122.8 N/mm (95 % CI: 110.7–134.8), rigidity of the SYMFIX construct 119.3 N/mm (95 % CI: 105.8–132.7). Displacement in the symphyseal area was mean 0.007 mm (95 % CI: 0.003–0.012) in the PLATE group and 0.021 mm (95 % CI: 0.011–0.031) in the SYMFIX group. Displacement in the sacroiliac joint area was mean 0.156 mm (95 % CI: 0.051–0.261) in the PLATE group and 0.120 mm (95 % CI: 0.039–0.201) in the SYMFIX group. Conclusions In comparison to standard internal plate fixation for the stabilization of open book pelvic ring injuries, symphyseal internal rod fixation using a multiaxial spinal screw-rod implant in vitro shows a similar rigidity and comparable low degrees of displacement.
    European Journal of Trauma and Emergency Surgery 04/2015; DOI:10.1007/s00068-015-0529-5 · 0.38 Impact Factor


Available from
Jun 6, 2014