Internal anterior fixators for pelvic ring injuries: Do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws?

Eagan, Michael; Kim, Hyunchul; Manson, Theodore T.; Gary, Joshua L.; Russell, Joseph P.; Hsieh, Adam H.; O’Toole, Robert V.; Boulton, Christina

doi:10.1016/j.injury.2015.01.040

Cited by 27 publications

(17 citation statements)

References 17 publications

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“…31 Another study confirmed this. 43 If polyaxial systems are chosen, we recommend the use of C-Clamps outside these screws to reinforce the construct (Fig. 1C) or using the Universal Spine System fracture module (Synthes Spine, Paoli, PA) which is very strong.…”

Section: Discussionmentioning

confidence: 99%

Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries

Vaidya

Martin

Roth

et al. 2017

Journal of Orthopaedic Trauma

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Section: Discussionmentioning

confidence: 99%

Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries

Vaidya

Martin

Roth

et al. 2017

Journal of Orthopaedic Trauma

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“…However, there are disadvantages to using an external fixator, including pin tract infection, loosening, skin impingement by pins, osteomyelitis, inconvenience regarding wound care and mobility, and negative effects on a patient’s quality of life [16, 17]. Particularly in diabetic and obese patients, external fixation is not recommended [16, 18]. External fixation can be a definitive treatment when accurate reduction and adequate fixation is obtained.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical characteristics of fixation methods for floating pubic symphysis

Song

Zhou

2017

J Orthop Surg Res

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BackgroundFloating pubic symphysis (FPS) is a relatively rare injury caused by high-energy mechanisms. There are several fixation methods used to treat FPS, including external fixation, subcutaneous fixation, internal fixation, and percutaneous cannulated screw fixation. To choose the appropriate fixation, it is necessary to study the biomechanical performance of these different methods. The goal of this study was to compare the biomechanical characteristics of six methods by finite element analysis.MethodsA three-dimensional finite element model of FPS was simulated. Six methods were used in the FPS model, including external fixation (Ext), subcutaneous rod fixation (Sub-rod), subcutaneous plate fixation (Sub-plate), superior pectineal plate fixation (Int-sup), infrapectineal plate fixation (Int-ifa), and cannulated screw fixation (Int-scr). Compressive and rotational loads were then applied in all models. Biomechanical characteristics that were recorded and analyzed included construct stiffness, micromotion of the fracture gaps, von Mises stress, and stress distribution.ResultsThe construct stiffness of the anterior pelvic ring was decreased dramatically when FPS occurred. Compressive stiffness was restored by the three internal fixation and Sub-rod methods. Unfortunately, rotational stiffness was not restored satisfactorily by the six methods. For micromotion of the fracture gaps, the displacement was reduced significantly by the Int-sup and Int-ifa methods under compression. The internal fixation methods and Sub-plate method performed well under rotation. The maximum von Mises stress of the implants was not large. For the plate-screw system, the maximum von Mises stress occurred over the region of the fracture and plate-screw joints. The maximum von Mises stress appeared on the rod-screw and screw-bone interfaces for the rod-screw system.ConclusionsThe present study showed the biomechanical advantages of internal fixation methods for FPS from a finite element view. Superior stabilization of the anterior pelvic ring and fracture gaps was obtained by internal fixation. Subcutaneous fixation had satisfactory outcomes as well. Sub-rod fixation offered good anti-compression, while the Sub-plate fixation provided favorable anti-rotational capacity.

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“…However, for obese patients, blunt dissection of the subcutaneous fascia may cause large trauma and damage to the lateral femoral cutaneous nerve. Vaidya proposed its indications including anterior pelvic injury with high, low, or bilateral rami fractures. All 45 patients in this study all had complex bilateral anterior pelvic ring fracture and received INFIX.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, care for INFIX placement is simple, and complications, such as needle path infection, loosening, and fixation failure, are avoidable. Patients feel more comfortable, their daily activities are not influenced, and the efficacy is satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures

Liu

Duan

Liu

et al. 2018

Robotics Computer Surgery

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PurposeThe purpose of this study was to investigate the safety and efficacy of the combination of robot‐assisted percutaneous screw placement and pelvic internal fixator (INFIX) for minimally invasive treatment of unstable anterior and posterior pelvic ring injuries.MethodsFrom September 2016 to June 2017, twenty‐four patients with unstable anterior and posterior pelvic ring injuries were treated with TiRobot‐assisted percutaneous sacroiliac cannulated screw fixation on the posterior pelvic ring combined with robot‐assisted pedicle screw placement in the anterior inferior iliac spine along with INFIX on the anterior pelvic ring. The results of the treatment, including surgery duration, fluoroscopy frequency, total drilling, amount of blood loss, fracture healing time, and postoperative functional outcomes were recorded and compared with another 21 similar patients who underwent conventional manual positioning surgery.ResultsThe TiRobot group incurred significantly shorter duration of surgery; less fluoroscopy frequency, intraoperative bleeding, and total drilling than in the conventional group (P < 0.05). Postoperative radiological follow‐up showed that all screws were in the safe area and no screw penetrated the cortex. All wounds healed by primary intention and no iatrogenic damage to the blood vessels, nerves, and organs occurred. Patients showed good tolerance to INFIX and reported no discomfort. The mean follow‐up duration was 5.4 months; the fractures were all healed, no loss of reduction occurred, and the mean Majeed score at the last follow‐up did not show any difference.ConclusionTiRobot‐assisted percutaneous screw placement combined with INFIX for the anterior and posterior pelvic ring injuries is accurate, safe, less invasive, and shows satisfactory efficacy, suggesting it is a better method for minimally invasive treatment of unstable pelvic ring fractures.

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Internal anterior fixators for pelvic ring injuries: Do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws?

Cited by 27 publications

References 17 publications

Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries

Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries

Biomechanical characteristics of fixation methods for floating pubic symphysis

Robot‐assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures

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