Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX

Reichel, Lee M.; MacCormick, Lauren M.; Dugarte, Anthony J.; Rizkala, Amir R.; Graves, Sara C.; Cole, Peter A.

doi:10.1016/j.injury.2017.12.009

Cited by 23 publications

(30 citation statements)

References 12 publications

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“…As a group, we reported on the safety and results of the pelvic bridge procedure utilizing a pelvic reconstruction plate 1 . Additionally, 2 cadaveric anatomic studies have shown the safety of the pelvic bridge as it relates to the lateral femoral cutaneous nerve; ilioinguinal nerve; iliohypogastric nerve; femoral artery, vein, and nerve; and spermatic cord or round ligament 3,4 . Because the pelvic bridge superficially parallels static anatomic structures (iliac crest, inguinal ligament, and pubic symphysis), it is very unlikely to impinge on underlying neurovascular structures.…”

Section: Resultsmentioning

confidence: 99%

The Pelvic Bridge

Cole

Hesse

Dugarte

et al. 2017

JBJS Essential Surgical Techniques

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Section: Resultsmentioning

confidence: 99%

The Pelvic Bridge

Cole

Hesse

Dugarte

et al. 2017

JBJS Essential Surgical Techniques

Self Cite

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“…This study was designed to determine the narrowing of safe ranges in screw insertion lengths in the supra‐acetabular area. Proper selection of angulation and screw insertion depths are essential to avoid breaching the pelvic wall and maintain full intraosseous containment . Safe transverse ranges increased caudally with values ranging from 6.0° ± 3.9° to 27.5° ± 4.1° for a 60 mm ISD.…”

Section: Discussionmentioning

confidence: 99%

“…No alteration in values of bisecting angles would be expected for most of the considered section because central to the safe ranges. Reports of using larger diameter screws, such as 7 mm, resulted in insertion difficulty for patients that do not have a broad width in their AIIS . There were limitations to how we explored the narrowing range with increasing screw depth as well.…”

Section: Discussionmentioning

confidence: 99%

“…Also, it is important to achieve total screw containment and avoid posterior cortex breaching which is determined from screw length and angles of insertion . With the exemption of Vaidya et al that suggested drilling of the screw in the direction of the posterior superior iliac spine just above the sciatic notch, in existing literature, screw angulation is often not disclosed . When it is disclosed, it is not supported by a criteria for its determination at time of surgery .…”

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confidence: 99%

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Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

Morandi

Daily

Kee

et al. 2019

Journal Orthopaedic Research

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In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra-acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross-sections over three-dimensional pelvic reconstructions at sagittal inclinations from 45°cranial to 45°caudal in 5°i ncrements. Templates of screw depths spanning 60-120 mm in 15 mm increments were disposed in the transverse plane from 45°medial to 45°lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60-mm depth resulted in the largest sagittal range (60.9°± 6.9°) and transverse range (27.5°± 4.1°) at 30°caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20°cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20°cranial to 30°caudal with an average of 27.9°± 1.2°(p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching.

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“…MPRSF combines the advantages of INFIX and pelvic bridging. The safety and effectiveness of minimally invasive xation of pelvic fractures have been demonstrated by several anatomic and clinical studies, although xation stability remains a concern [20,21]. Additionally, few studies have investigated whether these two xation techniques lead to su ciently strong implants and adequate biomechanical reduction.…”

Section: Risk Of Implant Failure and Micromotion In The Injury Modelmentioning

confidence: 99%

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

Ding

Chen

Huang

et al. 2020

Preprint

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Objectives: This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using Tornetta and Matta grading system and finite element analyses.Methods: In a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n=30) or INFIX (n=33). The main outcome measure were Majeed score, incidence of complications and adverse outcomes, and fixation stability was evaluated by finite element analysis (FEA).Results: two groups did not differ in terms of injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a higher satisfactory rate according to the Tornetta and Matta grading system than the INFIX group (73.33% vs 63.63%) as well as a higher Majeed score (81.5±10.4 vs 76.3±11.2), which was statistically significant at 6 months’ post-surgery. FEA showed that MPRSF was stiffer and more stable than INFIX and had a lower risk of implant failure.Conclusions: Both MPSRF and INFIX have acceptable biomechanical stability for the treatment of unstable pelvic anterior ring fractures. However, MPRSF has better fixation stability and lower risk of implant failure, which can lead to better clinical outcomes.

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Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX

Cited by 23 publications

References 12 publications

The Pelvic Bridge

The Pelvic Bridge

Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

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