Effect of Pin Location on Stability of Pelvic External Fixation

Kim, Weon-Yoo; Hearn, Trevor C.; Seleem, Osama A.; Mahalingam, Essai; Stephen, David; Tile, Marvin

doi:10.1097/00003086-199904000-00030

Cited by 115 publications

(72 citation statements)

References 13 publications

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“…Several articles have advocated constructs with a single pin in the dense supraacetabular region of each ilium [2,3,6]. One biomechanical study suggests these anteroinferior pins produce more stable constructs than conventional anterosuperior or iliac pins in rotationally and vertically unstable fracture patterns [9]. The pins are then connected to an external bar or a femoral distracter, which can help reduce the anterior pelvic injury [5].…”

Section: Introductionmentioning

confidence: 99%

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

Vaidya

Kubiak

Bergin

et al. 2012

Clinical Orthopaedics &Amp; Related Research

131

141

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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

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Section: Introductionmentioning

confidence: 99%

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

Vaidya

Kubiak

Bergin

et al. 2012

Clinical Orthopaedics &Amp; Related Research

131

141

View full text Add to dashboard Cite

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“…The external fixator still represents the gold standard for anterior transpubic pelvic fractures [11]. A variety of access points at the iliac crest are available for positioning; however, from a biomechanical point of view supraacetabular fixation represents the most stable connection [12]. Today, minimally invasive options have become available for this procedure, e.g.…”

Section: Introductionmentioning

confidence: 99%

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

Müller

Stosiek

Zellner

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF). Methods Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated. Results Overall, three patients (8.3 %) died, and 31 patients (86 %) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97 %) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5 % of the patients, and a fair or poor for 35.5 %. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population. Conclusions The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future.

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“…As shown previously [9,18,28,35], the standard SAEF will maintain the reduction of the pelvic ring. However, the compression across the symphysis and sacroiliac joint, which was obtained manually, is not retained by the fixator [15,16,25]. The C-clamp delivered high compression loads on the posterior pelvic ring [18].…”

Section: Discussionmentioning

confidence: 99%

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Sellei

Schandelmaier

Kobbe

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces. Questions/purposes We determined whether (1) an anterior external fixator with a second anterior articulation (X-frame) would provide posterior pelvic compression and (2) full pin insertion would deliver higher posterior compressive forces than half pin insertion. Methods We simulated AP compression Type III instability with plastic pelvis models and tested the following conditions: (1) single-pin supraacetabular external fixator (SAEF) using half pin insertion (60 mm); (2) SAEF using full pin insertion (120 mm); (3) modified fixator with X-frame using half pin insertion; (4) modified fixator using full pin insertion; and (5) C-clamp. Standardized fracture compression in the anterior and posterior compartment was performed as in previous studies by Gardner. A forcesensitive sensor was placed in the symphysis and posterior pelvic ring before fracture reduction and the fractures were reduced. The symphyseal and sacroiliac compression loads of each application were measured. Results The SAEF exerted mean compressions of 13 N and 14 N to the posterior pelvic ring using half and full pin insertions, respectively. The modified fixator had mean posterior compressions of 174 N and 222 N with half and full pin insertions, respectively. C-clamp application exerted a mean posterior load of 407 N. Conclusions Posterior compression on the pelvis was improved using an X-frame as an anterior fixation device in a synthetic pelvic fracture model. Clinical Relevance This additive device may improve the initial anterior and posterior stability in the acute management of unstable and life-threatening pelvic ring injuries.

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Effect of Pin Location on Stability of Pelvic External Fixation

Cited by 115 publications

References 13 publications

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

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

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

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