Complications of Anterior Subcutaneous Internal Fixation for Unstable Pelvis Fractures: A Multicenter Study

Abstract

Background Stabilization after a pelvic fracture can be accomplished with an anterior external fixator. These devices are uncomfortable for patients and are at risk for infection and loosening, especially in obese patients. As an alternative, we recently developed an anterior subcutaneous pelvic internal fixation technique (ASPIF).Questions/purposes We asked if the ASPIF (1) allows for definitive anterior pelvic stabilization of unstable pelvic injuries; (2) is well tolerated by patients for mobility and comfort; and (3) has an acceptable complication rate. Methods We retrospectively reviewed 91 patients who incurred an unstable pelvic injury treated with an anterior internal fixator and posterior fixation at four Level I trauma centers. We assessed (1) healing by callous formation on radiographs and the ability to weightbear comfortably; (2) patient function by their ability to sit, stand, lie on their sides, and how well they tolerated the implants; and (3) complications during the observation period. The minimum followup was 6 months (mean, 15 months; range, 6-40 months). Results All 91 patients were able to sit, stand, and lie on their sides. Injuries healed without loss of reduction in 89 of 91 patients. Complications included six early revisions resulting from technical error and three infections. Irritation of the lateral femoral cutaneous nerve was reported in 27 of 91 patients and resolved in all but one. Heterotopic ossification around the implants, which was asymptomatic in all cases, occurred in 32 of 91 patients. Conclusions The anterior internal fixator provided high rates of union for the anterior injury in unstable pelvic fractures. Patients were able to sit, stand and ambulate

Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone

“…In a recent multicentre report of 91 patients, we found that ASPIF is effective in the treatment of unstable pelvic fractures and avoids many of the complications associated with external fixation [7] (Fig. 1d).…”

“…External fixation is preferred in the acute setting due to its relative ease and speed of application [2][3][4][5]8]. However, complications associated with external fixation are numerous [7,8].…”

“…The complications associated with external pelvic frames include pin tract infection (2.5-50 %), osteomyelitis (0 to 7 %), loosening (0 to 19 %), skin compression (8 %), nerve damage (0-7 %), loss of reduction in up to 33 % of rotationally unstable injuries and up to 95 % of vertically unstable injures when used as a stand-alone device [7]. This improves to 0 to 8 % when combined with posterior fixation [7,8].…”

“…This improves to 0 to 8 % when combined with posterior fixation [7,8]. An anterior pelvic external fixator limits patient mobility, especially when sitting and when being rolled from side to side.…”

Sequential reduction and fixation for windswept pelvic ring injuries (LC3) corrects the deformity until healed

“…Windswept injuries account for about 6 % of pelvic fractures [4] but may account for 15 % of operated pelvic injuries [9]. In the treatment of certain pelvic injuries, the nature of the pattern and the remaining stability can be used to effectively reduce and stabilize the ring.…”