BackgroundExternal 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.MethodsA 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.ResultsTwenty-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.ConclusionsMinimally 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.Trial registration ACTRN12616001421426. Registered 12 October 2016. Retrospectively registered.

Therapeutic study, level V.

Incidental pulmonary nodules are common in the general population. This has implications for possible lung cancer screening recommendations in the Australian population. Referral and/or review systems are essential to ensure adequate follow up of incidental findings, as it is likely some patients are not receiving adequate follow up at present.

Background The COVID‐19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 Adult Major Trauma Service, and a designated COVID‐19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response. Methods The population of interest was all trauma patients captured in the hospital's Trauma Registry from March 16 th ‐September 10 th , 2016‐2020. Regression modelling assessed changes in mechanism and severity of the injury, and mortality during two lockdowns compared with the proceeding four years. Cases were matched with Hospital Administrative databases, to assess median time from admission to emergency CT scan, operating theatre, length of stay, and immediate surgery (OPSTAT). Results Throughout 2020, the hospital treated 525 COVID‐19 patients. Compared with previous years, there was up to a 34% reduction in major trauma and a 28% reduction in minor trauma admissions during the pandemic (p<0.05). ICU admissions were almost half of predicted. Some of the largest reductions were seen in motor vehicle crashes (49%) and falls (28%) (p<0.05). Time to CT, surgery and immediate surgery (OPSTAT) showed no change and having a suspected COVID‐19 diagnosis did not prolong any of these times except for the length of stay. Mortality was similar to previous years. Conclusion The COVID‐19 pandemic has had widespread societal changes, resulting in a substantial decrease in trauma presentations. Despite COVID's immense impact on the hospital's trauma service, the quality of care was not impaired.

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