Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis

Patel, Shwetak; Aggarwal, Sameer; Jindal, Karan; Kumar, Vishal; Sharma, Sudhaa

doi:10.1007/s00402-020-03742-7

Cited by 18 publications

(14 citation statements)

References 42 publications

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“…To address these treatment challenges, in 2009, Kuttert et al performed the first anterior ring fixation for unstable pelvic fractures using INFIX [ 27 ]. INFIX has since become a popular treatment technique for unstable pelvic fractures, with reported benefits including reduced soft tissue injury, less blood loss, and low incidence of intraoperative iatrogenic nerve injury [ 7 – 9 ]. Studies investigating the biomechanics, anatomy, and clinical outcomes of INFIX have found that INFIX may provide adequate pelvic stability and achieve good clinical outcomes, despite its associated complications [ 27 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury

et al. 2022

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Background The aim of this study is to compare the clinical and biomechanical outcome of INFIX plus single with two sacroiliac screw fixation for unstable pelvic fractures of Type C. Methods Sixteen cadavers were randomly subjected to INFIX plus single or double sacroiliac screw fixations and then mounted onto the ElectroForce loading machine under different vertical loads. To investigate the clinical outcomes of the two techniques, nineteen patients were retrospectively analyzed. The main outcome measures were postoperative radiographic reduction grading (using the Tornetta and Matta grading system), functional outcome (using the Majeed scoring system), and incidence of complications. Results In the biomechanical study, INFIX plus double sacroiliac screw fixation showed better biomechanical stability than fixation with a single sacroiliac screw (p < 0.05). In our clinical case series, all 19 patients had bony union 6 months after the operation. INFIX plus double sacroiliac screw fixation also demonstrated a better functional outcome and a higher radiographic satisfactory rate than INFIX plus single sacroiliac screw fixation (79.25 ± 5.47; 91.33 ± 4.97; p < 0.05), (77.78% vs. 60%; p = 0.05). One patient in INFIX plus single-screw fixation group had screw loosening at 6-month follow-up postoperatively. One case in each group suffered heterotopic ossification and the lateral femoral cutaneous nerve paralysis, and one patient suffered from infection. Conclusion INFIX plus double sacroiliac screw fixation demonstrated more stability in cadaveric biomechanical analysis and better clinical outcomes than INFIX plus single sacroiliac screw fixation.

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Section: Discussionmentioning

confidence: 99%

A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury

et al. 2022

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“…To address these treatment challenges, in 2009, Kuttert et al performed the rst anterior ring xation for unstable pelvic fractures using INFIX [27]. INFIX has since become a popular treatment technique for unstable pelvic fractures, with reported bene ts including reduced soft tissue injury, less blood loss, and low incidence of intraoperative iatrogenic nerve injury [7][8][9]. Studies investigating the biomechanics, anatomy, and clinical outcomes of INFIX have found that INFIX may provide adequate pelvic stability and achieve good clinical outcomes, despite its associated complications [27][28][29][30].…”

Section: Treatment Of Anterior Pelvic Ring Fracturesmentioning

confidence: 99%

“…External xation is mainly used in the emergency department to achieve hemodynamic stability, with potential complications including poor patient tolerance, postoperative infection, aseptic loosening, and joint dyskinesia [4][5][6]. Anterior subcutaneous internal xation (INFIX) has recently been proposed by several scholars as a minimally invasive technique to treat anterior pelvic ring injury, with proposed bene ts including shorter operative times, smaller wound size, less periosteal stripping, and adequate functional outcomes compared to traditional techniques [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

A Clinical and Biomechanical Comparison of INFIX Plus Single Versus Double Sacroiliac Screw Fixation for Unstable Pelvic Ring Injury

Chen

Ding

Liu

et al. 2022

Preprint

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Background The aim of this study is to compare the clinical and biomechanical outcome of INFIX plus single with two sacroiliac screw fixation for unstable pelvic fractures of Type C. Methods Sixteen cadavers were randomly subjected to INFIX plus single or double sacroiliac screw fixations, and then mounted onto the Electroforce loading machine under different vertical load. To investigate the clinical outcomes of the two techniques, Nineteen patients were retrospectively analyzed. The main outcome measures were postoperative radiographic reduction grading (using the Tornetta and Matta grading system), functional outcome (using the Majeed scoring system), and incidence of complications. Results In the biomechanical study, INFIX plus double sacroiliac screw fixation showed better biomechanical stability than fixation with a single sacroiliac screw (p < 0.05). In our clinical case-series, all 19 patients had bony union 6 months after the operation. INFIX plus double sacroiliac screw fixation also demonstrated a better functional outcome and a higher radiographic satisfactory rate than INFIX plus single sacroiliac screw fixation (79.25±5.47; 91.33±4.97; p<0.05), ( 77.78% vs. 60%; p = 0.05). One patient in INFIX plus single screw fixation group had screw loosening at follow-up 6 months postoperatively. One case in each group suffered heterotopic ossification and the lateral femoral cutaneous nerve paralysis, and one patient suffered from infection. Conclusion INFIX plus double sacroiliac screw fixation demonstrated more stability in cadaveric biomechanical analysis and better clinical outcomes than INFIX plus single sacroiliac screw fixation.

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“…The technique of INFIX (internal fixator) consists of two LC II screws, which are implanted from the upper anterior inferior iliac spine (AIIS) to posterior superior iliac spine (PSIS) of both ilium and a subcutaneous connected rod. It has been widely used in the treatment of anterior pelvic ring fracture due to its advantages of being a minimally invasive procedure, having reasonable biomechanical model, providing enough fixing strength, and having satisfactory fracture healing rate 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Posterior INFIX for Treating Unilateral Unstable Sacral Fractures

Geng

et al. 2022

Orthopaedic Surgery

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Objective To evaluate the clinical outcomes of the treatment of unilateral unstable sacral fractures by fixation with the posterior INFIX (posterior pelvic ring screw‐rod internal fxation). Methods Data of 60 patients with unilateral unstable sacral fractures who underwent surgery from March 2013 to March 2020 were retrospectively analyzed according to the selection criteria. All patients were associated with anterior pelvic ring injuries, and the operations were performed by the same team of surgeons. According to the different types of internal fixation, the patients were divided into two groups, which both included 30 patients: the posterior INFIX group and iliosacral screw fixation group. The demographic and clinical data of the two patient groups, such as age, sex, sacral fracture types based on the Denis classification, operation time, amount of intraoperative bleeding, intraoperative fluoros copy time, Majeed pelvic score at final follow‐up, and quality of fracture reduction based on Mears and Velyvis's imaging classification criteria were collected by the same researcher and compared statistically. Results All patients were continuously followed up for 23.17 ± 3.34 months (range, 12 to 46 months). All sacral fractures healed with an average healing time of 9.3 ± 2.24 months (range, 6 to 18 months). None of the patients had re‐displacement of the fracture or fixation failure. Compared to the iliosacral screw group, the posterior INFIX group patients had more intraoperative bleeding (t = 3.59, P < 0.001), shorter operation time (t = 4.49, P < 0.001), and shorter intraoperative fluoroscopy time (t = 6.26, P < 0.001). There were no statistical differences between the two groups in terms of age, sex, fracture type, Majeed score, and quality of fracture reduction (P > 0.05). In the posterior INFIX group, one patient had a superficial wound infection and one patient complained of discomfort due to a prominent fixation. In the iliosacral screw fixation group, one patient had intraoperative iatrogenic S1 nerve injury and vessel injury. The posterior INFIX fixation was a simpler manipulation with higher safety, shorter time of operation and intraoperative fluoroscopy, and similar clinical outcomes compared to iliosacral screw fixation. Conclusion For the treatment of unilateral unstable sacral fractures, the posterior INFIX fixation can be recommended in clinic application.

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Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis

Cited by 18 publications

References 42 publications

A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury

A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury

A Clinical and Biomechanical Comparison of INFIX Plus Single Versus Double Sacroiliac Screw Fixation for Unstable Pelvic Ring Injury

Posterior INFIX for Treating Unilateral Unstable Sacral Fractures

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