title: 13-Year experience in external fixation of the pelvis: complications, reduction and removal.
abstract: OBJECTIVE
  To evaluate the complications associated with anterior pelvic external fixation and the success of this device in maintaining reduction when used in conjunction with sacroiliac screws.
  
  
  METHODS
  Through a retrospective clinical study at an academic Level I Trauma Center, 129 patients fit the criteria for inclusion with a mean duration of anterior pelvic external fixation of 62 days and mean follow-up of 360 days. Charts were reviewed for complications postoperatively. The symphysis diastasis, vertical displacement and posterior displacement of each hemipelvis were quantified from pelvic radiographs.
  
  
  RESULTS
  Of the 129 patients receiving anterior pelvic external fixation, 14 (10.9 %) presented to an emergency department for problems with their anterior pelvic external fixation. Of these 14 patients, 7 (5.4 %) required readmission, all for infectious concerns necessitating IV antibiotics. 6 (4.7 %) required formal operative debridement and device removal. 13 patients (10.1 %) had superficial pin site infections successfully treated with oral antibiotics. Reduction was maintained (rated as fair, good or excellent) in all patients with radiographic follow-up (n = 74, average radiographic follow-up of 216 days) following removal of their anterior pelvic external fixation. 38 patients (30.4 %) had their anterior pelvic external fixation removed in clinic, while 87 (69.6 %) had formal removal in the operating room.
  
  
  CONCLUSIONS
  While previous data suggest high complication rates in definitive anterior pelvic external fixation, we present the largest cohort of patients receiving anterior pelvic external fixation and sacroiliac screws, demonstrating a low complication rate while maintaining reduction of the pelvic ring. In addition, we found that these devices could be reliably removed in a clinic setting.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. Phillip.m.mitchell@vanderbitl.edu.
authors.forename: P M
authors.initials: PM
authors.lastname: Mitchell
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. chad.m.corrigan@vanderbilt.edu.
authors.forename: C M
authors.initials: CM
authors.lastname: Corrigan
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. neelam.a.patel@vanderbilt.edu.
authors.forename: N A
authors.initials: NA
authors.lastname: Patel
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. ajsilverberg11@gmail.com.
authors.forename: A J
authors.initials: AJ
authors.lastname: Silverberg
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. Sarah.e.greenberg@vanderbilt.edu.
authors.forename: S E
authors.initials: SE
authors.lastname: Greenberg
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. Rachel.thakore@vanderbilt.edu.
authors.forename: R V
authors.initials: RV
authors.lastname: Thakore
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. William.obremskey@vanderbilt.edu.
authors.forename: W T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. jesse.ehrenfeld@vanderbilt.edu.
authors.forename: J M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. Jason.evans@vanderbilt.edu.
authors.forename: J M
authors.initials: JM
authors.lastname: Evans
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA. manish.sethi@vanderbilt.edu.
authors.forename: M K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D001863:Bone Screws; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior pelvic external fixation (APEF); External fixation; Pelvis; Sacroiliac screws