title: Femoral nerve palsy after pelvic fracture treated with INFIX: a case series.
abstract: OBJECTIVE
  The treatment of some pelvic injuries has evolved recently to include the use of a subcutaneous anterior pelvic fixator (INFIX). We present 8 cases of femoral nerve palsy in 6 patients after application of an INFIX to highlight this potentially devastating complication to pelvic surgeons using this technique and discuss how it might be avoided in the future.
  
  
  METHODS
  Retrospective chart review. Case series.
  
  
  METHODS
  Five level 1 and 2 trauma centers, tertiary referral hospitals.
  
  
  METHODS
  Six patients with anterior pelvic ring injury treated with an INFIX who experienced 8 femoral nerve palsies (2 bilateral).
  
  
  METHODS
  Removal of internal fixator, treatment for femoral nerve palsy.
  
  
  METHODS
  Clinical and electromyographic evaluation of patients.
  
  
  RESULTS
  All 6 patients with a total of 8 femoral nerve palsies had their INFIX removed. Variable resolution of the nerve injuries was observed.
  
  
  CONCLUSIONS
  Application of an INFIX for the treatment of pelvic ring injury carries a potentially devastating risk to the femoral nerve(s). Despite early implant removal after detection of nerve injury, some patients had residual quadriceps weakness, disturbance of the thigh's skin sensation, and/or gait disturbance attributable to femoral nerve palsy at the time of early final follow-up.
  
  
  METHODS
  Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Queens University, Kingston, Ontario, Canada; †Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA; ‡Los Angeles Orthopaedic Specialists, Los Angeles, CA; §Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; ‖Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN; and ¶Harris Methodist Fort Worth Hospital, Fort Worth, TX.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hesse
authors.forename: Utku
authors.initials: U
authors.lastname: Kandmir
authors.forename: Brian
authors.initials: B
authors.lastname: Solberg
authors.forename: Alex
authors.initials: A
authors.lastname: Stroh
authors.forename: Greg
authors.initials: G
authors.lastname: Osgood
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Sems
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
mesh_terms: D000328:Adult; D005260:Female; D005267:Femoral Nerve / Q000293:injuries*; D020428:Femoral Neuropathy / Q000209:etiology*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies