Modified internal fixator combined with sacroiliac screws in treatment of Tile C1.3 pelvic fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YE Longfei , GUAN Jianzhong , WANG Xiaopan , CHEN Xiaotian , LU Hongxin , XIAO Yuzhou , DAI Xiusong ,  WU Min

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China;

Corresponding author：

WU Min, Email: wumin200207@163.com

Keywords：

Pelvic fracture; internal fixator; anterior pelvic ring; internal fixation

DOI：

10.7507/1002-1892.202208014

Video：

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Objective To investigate the effectiveness of modified internal fixator (INFIX) to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX. Methods The patients with Tile C1.3 pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects. Of them, 55 cases were included in the study according to the selection criteria. During operation, the anterior pelvic ring was fixed with the modified INFIX in 30 cases (modified group) and with the traditional INFIX in 25 cases (control group). The posterior pelvic ring in 55 cases was fixed with sacroiliac screws. There was no significant difference between the two groups in gender, age, cause of injury, time from injury to operation, and combined injury (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation, grade the reduction according to the Matta scoring standards, and observe the fracture healing and healing time. The function was evaluated according to Majeed scoring standards during follow-up. Results The operation time of the modified group was significantly longer than that of the control group (Z=–3.837, P<0.001), but there was no significant difference in the intraoperative blood loss between the two groups (t=–1.831, P=0.076). All patients were followed up 12-18 months (mean, 14 months). X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%, which was significantly better than that in the control group (63.33%) (χ²=4.373, P=0.037). All fractures healed, and the fracture healing time of the modified group and the control group was (12.04±3.59) and (14.83±4.83) weeks respectively, with a significant difference (t=2.401, P=0.020). At last follow-up, the excellent and good rates of Majeed scoring were 80.00% in the modified group and 76.67% in the control group, with no significant difference (χ²=0.089, P=0.766). In the modified group, 2 cases (8%) had complications, all of which were incision infection above pubic symphysis. In the control group, 9 cases (30%) had complications, including 5 cases of lateral femoral cutaneous nerve injury, 2 cases of femoral nerve paralysis, and 2 cases of delayed fracture healing. The incidence of complications was significantly lower in the modified group than in the control group (χ²=4.125, P=0.042). Conclusion Compared with the traditional INFIX, the modified INFIX to fix the anterior pelvic ring for Tile C1.3 pelvic fracture has fewer complications, better stability, shorter fracture healing time, and lower risk of nerve injury.

Citation： YE Longfei, GUAN Jianzhong, WANG Xiaopan, CHEN Xiaotian, LU Hongxin, XIAO Yuzhou, DAI Xiusong, WU Min. Modified internal fixator combined with sacroiliac screws in treatment of Tile C1.3 pelvic fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(12): 1447-1452. doi: 10.7507/1002-1892.202208014 Copy

1.	武建超, 师政伟, 周建伟, 等. 骨盆前环骨折微创治疗研究进展. 中国修复重建外科杂志, 2020, 34(4): 529-535.
2.	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. doi: 10.1038/s41598-019-39068-7.
3.	吴刚, 谭伦, 李邦青, 等. 微创经皮桥式内固定支架与传统外固定支架治疗不稳定骨盆骨折疗效比较. 中国修复重建外科杂志, 2020, 34(5): 563-568.
4.	Bagga R, Shetty AP, Kanna RM, et al. INFIX/EXFIX: Innovation managing pelvic fractures in difficult scenarios. J Postgrad Med, 2019, 65(3): 177-180.
5.	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.
6.	Sharma S, Aggarwal S, Patel S, et al. INFIX-safe and effective surgical option for complex fracture patterns of the anterior pelvic ring: A prospective single center study. J Orthop, 2021, 23: 142-149.
7.	Vaidya R, Amar K, Woodbury D, et al. Infection after the use of INFIX in pelvic ring injuries. SICOT J, 2021, 7: 46. doi: 10.1051/sicotj/2021047.
8.	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.
9.	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. doi: 10.1186/s12938-019-0648-z.
10.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
11.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
12.	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. doi: 10.1186/s13018-022-03133-1.
13.	刘志勤, 刘康, 邱尔钺, 等. INFIX内置支架系统联合骶髂螺钉内固定治疗Tile C型不稳定骨盆骨折疗效观察. 中国骨与关节损伤杂志, 2022, 37(2): 170-172.
14.	Hesse D, Kandmir U, Solberg B, et al. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma, 2015, 29(3): 138-143.
15.	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. doi: 10.1186/s13018-021-02387-5.
16.	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.
17.	Jain M, Nanda SN, Mohapatra SS, et al. Bladder incarceration following anterior pelvic infix of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation. J Clin Orthop Trauma, 2017, 8(Suppl 1): S11-S16.

1. 武建超, 师政伟, 周建伟, 等. 骨盆前环骨折微创治疗研究进展. 中国修复重建外科杂志, 2020, 34(4): 529-535.
2. 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. doi: 10.1038/s41598-019-39068-7.
3. 吴刚, 谭伦, 李邦青, 等. 微创经皮桥式内固定支架与传统外固定支架治疗不稳定骨盆骨折疗效比较. 中国修复重建外科杂志, 2020, 34(5): 563-568.
4. Bagga R, Shetty AP, Kanna RM, et al. INFIX/EXFIX: Innovation managing pelvic fractures in difficult scenarios. J Postgrad Med, 2019, 65(3): 177-180.
5. 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.
6. Sharma S, Aggarwal S, Patel S, et al. INFIX-safe and effective surgical option for complex fracture patterns of the anterior pelvic ring: A prospective single center study. J Orthop, 2021, 23: 142-149.
7. Vaidya R, Amar K, Woodbury D, et al. Infection after the use of INFIX in pelvic ring injuries. SICOT J, 2021, 7: 46. doi: 10.1051/sicotj/2021047.
8. 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.
9. 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. doi: 10.1186/s12938-019-0648-z.
10. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
11. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
12. 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. doi: 10.1186/s13018-022-03133-1.
13. 刘志勤, 刘康, 邱尔钺, 等. INFIX内置支架系统联合骶髂螺钉内固定治疗Tile C型不稳定骨盆骨折疗效观察. 中国骨与关节损伤杂志, 2022, 37(2): 170-172.
14. Hesse D, Kandmir U, Solberg B, et al. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma, 2015, 29(3): 138-143.
15. 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. doi: 10.1186/s13018-021-02387-5.
16. 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.
17. Jain M, Nanda SN, Mohapatra SS, et al. Bladder incarceration following anterior pelvic infix of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation. J Clin Orthop Trauma, 2017, 8(Suppl 1): S11-S16.

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Chinese Journal of Reparative and Reconstructive Surgery

Modified internal fixator combined with sacroiliac screws in treatment of Tile C1.3 pelvic fracture

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