A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures.
BACKGROUND
External fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod.


METHODS
A single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications.


RESULTS
Twenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44-65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar.


CONCLUSIONS
Minimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised.


BACKGROUND
ACTRN12616001421426 . Registered 12 October 2016. Retrospectively registered.
Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia. waynehoskins@icloud.com.|Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia. waynehoskins@icloud.com.
Wayne
W
Hoskins
Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia.
Andrew
A
Bucknill
Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia.
James
J
Wong
Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia.
Edward
E
Britton
Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Rodney
R
Judson
Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Kellie
K
Gumm
Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Roselyn
R
Santos
Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia.
Rohan
R
Sheehy
Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK.|John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford, UK.
Xavier
X
Griffin
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D011446:Prospective Studies; D055815:Young Adult
Bones; Fracture fixation; Fractures; Pelvis; Wounds and injuries