Research progress of anterior subcutaneous internal fixator in pelvic fracture_West China Medical Journal

Authors：

LIN Yixiang , QIN Weicheng , YIN Yijie , Kenmegne Guy Romeo , HUANG Shenbo ,  FANG Yue

Trauma Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FANG Yue, Email: fangyue1968@163.com

Keywords：

Pelvic fracture; internal fixation; anterior subcutaneous internal fixator; research progress

DOI：

10.7507/1002-0179.202207173

Video：

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Pelvic fractures are often caused by high-energy trauma. The condition of patients is complex and requires active therapy. The treatment of pelvic fractures includes conservative and surgical treatment. Surgical treatment is suitable for patients with unstable pelvic fractures. In recent years,the anterior subcutaneous internal fixator (INFIX) for the treatment of unstable pelvic fractures has been popularized and achieved extraordinary outcomes. INFIX is a relatively novel technology for the treatment of anterior pelvic ring fractures. It has excellent biomechanical properties, a wide range of indications, and has the advantages of minimally invasive, convenient care, fewer complications, and better clinical outcomes. If patients with anterior pelvic ring fractures have the indications for INFIX after careful evaluation, INFIX is recommended. This article summarizes the research progress of INFIX in the treatment of anterior pelvic ring fractures, and summarizes its surgical methods, biomechanical properties, indications, advantages, complications and clinical outcomes.

Citation： LIN Yixiang, QIN Weicheng, YIN Yijie, Kenmegne Guy Romeo, HUANG Shenbo, FANG Yue. Research progress of anterior subcutaneous internal fixator in pelvic fracture. West China Medical Journal, 2022, 37(10): 1565-1568. doi: 10.7507/1002-0179.202207173 Copy

1.	Kumbhare C, Meena S, Kamboj K, et al. Use of INFIX for managing unstable anterior pelvic ring injuries: a systematic review. J Clin Orthop Trauma, 2020, 11(6): 970-975.
2.	Wu S, Chen J, Yang Y, et al. Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases. J Orthop Surg Res, 2021, 16(1): 350.
3.	Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot, 2018, 14(5): e1927.
4.	陈华, 白雪东, 易成腊, 等. 中国骨盆骨折微创手术治疗指南(2021). 中华创伤骨科杂志, 2021, 23(1): 4-14.
5.	Cole PA, Dyskin EA, Gilbertson JA. Minimally-invasive fixation for anterior pelvic ring disruptions. Injury, 2015, 46(Suppl 3): S27-S34.
6.	Lee C, Sciadini M. The use of external fixation for the management of the unstable anterior pelvic ring. J Orthop Trauma, 2018, 32(Suppl 6): S14-S17.
7.	Steer R, Balendra G, Matthews J, et al. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J, 2019, 5: 22.
8.	Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
9.	Smith A, Malek IA, Lewis J, et al. Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique. J Orthop Surg (Hong Kong). 2017, 25(1): 2309499016684994.
10.	Bi C, Wang Q, Wu J, et al. Modified pedicle screw-rod fixation versus anterior pelvic external fixation for the management of anterior pelvic ring fractures: a comparative study. J Orthop Surg Res, 2017, 12(1): 185.
11.	Hua X, Yan SG, Cui Y, et al. Minimally invasive internal fixator for unstable pelvic ring injuries with a pedicle screw-rod system: a retrospective study of 23 patients after 13.5 months. Arch Orthop Trauma Surg, 2019, 139(4): 489-496.
12.	Pan ZH, Chen FC, Huang JM, et al. Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable anterior pelvic ring fracture: a retrospective study and finite element analysis. J Orthop Surg Res, 2021, 16(1): 467.
13.	Scherer J, Tiziani S, Sprengel K, et al. Subcutaneous internal anterior fixation of pelvis fractures-which configuration of the InFix is clinically optimal?-a retrospective study. Int Orthop, 2019, 43(9): 2161-2166.
14.	Becker CA, Kammerlander C, Kußmaul AC, et al. Modified less invasive anterior subcutaneous fixator for unstable tile-C-pelvic ring fractures: a biomechanical study. Biomed Eng Online, 2019, 18(1): 38.
15.	Chen H, Ding C, Liu Y, et al. A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury. J Orthop Surg Res, 2022, 17(1): 285.
16.	Liu L, Zeng D, Fan S, et al. Biomechanical study of tile C3 pelvic fracture fixation using an anterior internal system combined with sacroiliac screws. J Orthop Surg Res, 2021, 16(1): 225.
17.	Liu L, Fan S, Zeng D, et al. Clinical application of anterior ring internal fixator system combined with sacroiliac screw fixation in tile C pelvic fracture treatment. J Orthop Surg Res, 2021, 16(1): 715.
18.	Stevenson AJ, Swartman B, Bucknill AT. Percutaneous internal fixation of pelvic fractures. Unfallchirurg, 2017, 120(Suppl 1): 10-18.
19.	Nandi R, Rahman M, Kumar A, et al. Effectiveness of anterior subcutaneous internal fixation (INFIX) in the management of potentially infected pelvis fractures. J Clin Orthop Trauma, 2020, 11(6): 1128-1135.
20.	Cai L, Lou Y, Guo X, et al. Surgical treatment of unstable pelvic fractures with concomitant acetabular fractures. Int Orthop, 2017, 41(9): 1803-1811.
21.	Yin Y, Luo J, Zhang R, et al. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep, 2019, 9(1): 2578.
22.	Fahmy M, Abdelmoneim MA. Operative intervention of unstable paediatric pelvic fracture: radiological and functional assessment. Eur J Trauma Emerg Surg, 2022, 48(1): 187-194.
23.	Timmer RA, Verhage SM, Krijnen P, et al. Indications for surgical fixation of low-energy pelvic ring fractures in elderly: a systematic review. Arch Orthop Trauma Surg, 2022: 25.
24.	Patel S, Aggarwal S, Jindal K, et al. Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2022, 142(5): 787-803.
25.	Du W, Sun T, Ding Y, et al. Robot-assisted treatment of unstable pelvic fractures with a percutaneous iliac lumbar double rod fixation combined with a percutaneous pelvic anterior ring INFIX fixation. Int Orthop, 2020, 44(6): 1223-1232.
26.	Chen K, Yao S, Yang F, et al. Minimally invasive screw fixation of unstable pelvic fractures using the “blunt end” kirschner wire technique assisted by 3D printed external template. Biomed Res Int, 2019: 1524908.
27.	Hiyama A, Ukai T, Nomura S, et al. The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note. J Orthop Surg Res, 2022, 17(1): 32.
28.	Meyers C, Lisiecki J, Miller S, et al. Heterotopic ossification: a comprehensive review. JBMR Plus, 2019, 3(4): e10172.
29.	Vaidya R, Woodbury D, Nasr K. Anterior subcutaneous internal pelvic fixation/INFIX: a systemic review. J Orthop Trauma, 2018, 32(Suppl 6): S24-S30.
30.	Ge Y, Zhao C, Wang Y, et al. Robot-assisted autonomous reduction of a displaced pelvic fracture: a case report and brief literature review. J Clin Med, 2022, 11(6): 1598.
31.	Suda AJ, Helm L, Obertacke U. Pelvic antropometric measurement in 3D CT for placement of two unilateral iliosacral S1-7.3 mm screws. Int Orthop, 2021, 45(12): 3179-3184.

1. Kumbhare C, Meena S, Kamboj K, et al. Use of INFIX for managing unstable anterior pelvic ring injuries: a systematic review. J Clin Orthop Trauma, 2020, 11(6): 970-975.
2. Wu S, Chen J, Yang Y, et al. Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases. J Orthop Surg Res, 2021, 16(1): 350.
3. Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot, 2018, 14(5): e1927.
4. 陈华, 白雪东, 易成腊, 等. 中国骨盆骨折微创手术治疗指南(2021). 中华创伤骨科杂志, 2021, 23(1): 4-14.
5. Cole PA, Dyskin EA, Gilbertson JA. Minimally-invasive fixation for anterior pelvic ring disruptions. Injury, 2015, 46(Suppl 3): S27-S34.
6. Lee C, Sciadini M. The use of external fixation for the management of the unstable anterior pelvic ring. J Orthop Trauma, 2018, 32(Suppl 6): S14-S17.
7. Steer R, Balendra G, Matthews J, et al. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J, 2019, 5: 22.
8. Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
9. Smith A, Malek IA, Lewis J, et al. Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique. J Orthop Surg (Hong Kong). 2017, 25(1): 2309499016684994.
10. Bi C, Wang Q, Wu J, et al. Modified pedicle screw-rod fixation versus anterior pelvic external fixation for the management of anterior pelvic ring fractures: a comparative study. J Orthop Surg Res, 2017, 12(1): 185.
11. Hua X, Yan SG, Cui Y, et al. Minimally invasive internal fixator for unstable pelvic ring injuries with a pedicle screw-rod system: a retrospective study of 23 patients after 13.5 months. Arch Orthop Trauma Surg, 2019, 139(4): 489-496.
12. Pan ZH, Chen FC, Huang JM, et al. Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable anterior pelvic ring fracture: a retrospective study and finite element analysis. J Orthop Surg Res, 2021, 16(1): 467.
13. Scherer J, Tiziani S, Sprengel K, et al. Subcutaneous internal anterior fixation of pelvis fractures-which configuration of the InFix is clinically optimal?-a retrospective study. Int Orthop, 2019, 43(9): 2161-2166.
14. Becker CA, Kammerlander C, Kußmaul AC, et al. Modified less invasive anterior subcutaneous fixator for unstable tile-C-pelvic ring fractures: a biomechanical study. Biomed Eng Online, 2019, 18(1): 38.
15. Chen H, Ding C, Liu Y, et al. A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury. J Orthop Surg Res, 2022, 17(1): 285.
16. Liu L, Zeng D, Fan S, et al. Biomechanical study of tile C3 pelvic fracture fixation using an anterior internal system combined with sacroiliac screws. J Orthop Surg Res, 2021, 16(1): 225.
17. Liu L, Fan S, Zeng D, et al. Clinical application of anterior ring internal fixator system combined with sacroiliac screw fixation in tile C pelvic fracture treatment. J Orthop Surg Res, 2021, 16(1): 715.
18. Stevenson AJ, Swartman B, Bucknill AT. Percutaneous internal fixation of pelvic fractures. Unfallchirurg, 2017, 120(Suppl 1): 10-18.
19. Nandi R, Rahman M, Kumar A, et al. Effectiveness of anterior subcutaneous internal fixation (INFIX) in the management of potentially infected pelvis fractures. J Clin Orthop Trauma, 2020, 11(6): 1128-1135.
20. Cai L, Lou Y, Guo X, et al. Surgical treatment of unstable pelvic fractures with concomitant acetabular fractures. Int Orthop, 2017, 41(9): 1803-1811.
21. Yin Y, Luo J, Zhang R, et al. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep, 2019, 9(1): 2578.
22. Fahmy M, Abdelmoneim MA. Operative intervention of unstable paediatric pelvic fracture: radiological and functional assessment. Eur J Trauma Emerg Surg, 2022, 48(1): 187-194.
23. Timmer RA, Verhage SM, Krijnen P, et al. Indications for surgical fixation of low-energy pelvic ring fractures in elderly: a systematic review. Arch Orthop Trauma Surg, 2022: 25.
24. Patel S, Aggarwal S, Jindal K, et al. Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2022, 142(5): 787-803.
25. Du W, Sun T, Ding Y, et al. Robot-assisted treatment of unstable pelvic fractures with a percutaneous iliac lumbar double rod fixation combined with a percutaneous pelvic anterior ring INFIX fixation. Int Orthop, 2020, 44(6): 1223-1232.
26. Chen K, Yao S, Yang F, et al. Minimally invasive screw fixation of unstable pelvic fractures using the “blunt end” kirschner wire technique assisted by 3D printed external template. Biomed Res Int, 2019: 1524908.
27. Hiyama A, Ukai T, Nomura S, et al. The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note. J Orthop Surg Res, 2022, 17(1): 32.
28. Meyers C, Lisiecki J, Miller S, et al. Heterotopic ossification: a comprehensive review. JBMR Plus, 2019, 3(4): e10172.
29. Vaidya R, Woodbury D, Nasr K. Anterior subcutaneous internal pelvic fixation/INFIX: a systemic review. J Orthop Trauma, 2018, 32(Suppl 6): S24-S30.
30. Ge Y, Zhao C, Wang Y, et al. Robot-assisted autonomous reduction of a displaced pelvic fracture: a case report and brief literature review. J Clin Med, 2022, 11(6): 1598.
31. Suda AJ, Helm L, Obertacke U. Pelvic antropometric measurement in 3D CT for placement of two unilateral iliosacral S1-7.3 mm screws. Int Orthop, 2021, 45(12): 3179-3184.

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