The Pelvic Bridge

Cole, Peter A.; Hesse, Daniel; Dugarte, Anthony J.; Dyskin, Evgeny

doi:10.2106/jbjs.st.15.00085

Cited by 7 publications

(10 citation statements)

References 4 publications

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“…20,21 Complications include: pin-tract infection in 2.5-50% of cases, osteomyelitis, aseptic loosening in up to 19%, patient discomfort, and poor tolerance due to limitations in activities of daily living or mobility or skin impingement, increased difficulty in nursing care and iatrogenic nerve injury. 5,15,[20][21][22] There is also a risk of loss of reduction, which is dependent on the fracture pattern and additional fixation used. 20 The presence of obesity further increases the risk of loss of reduction and pin-tract complications.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 The bridge is passed subcutaneously, above the external oblique fascia, along the static anatomic structures namely the iliac crest, inguinal ligament and pubic symphysis. 4,5,22 The construct design can allow for either selective percutaneous fixation of the compromised hemipelvis without involving the uninjured side, or two separate fixators can be used with an overlap and rod-to-rod connections at the pubic symphysis for bilateral fractures. 5 These differences in the course of the connecting rod and construct design provide some advantage over the INFIX.…”

Section: Discussionmentioning

confidence: 99%

“…This is recommended as there are no long-term studies available, and potentially deleterious consequences from leaving the device in situ are unknown. 5,22 Pressure over the device can also cause unnecessary discomfort for the patient. 22 Current literature recommends removal of the pelvic bridge between eight and 16 weeks, before excessive soft tissue ingrowth can occur.…”

Section: Discussionmentioning

confidence: 99%

“…5,22 Pressure over the device can also cause unnecessary discomfort for the patient. 22 Current literature recommends removal of the pelvic bridge between eight and 16 weeks, before excessive soft tissue ingrowth can occur. 5,34 Campbell et al described a novel endoscopic technique utilising incisions smaller than those of the original procedure, to successfully remove the implant with excellent preliminary results.…”

Section: Discussionmentioning

confidence: 99%

“…It is also proving to be advantageous in coagulopathic patients to minimise intraoperative blood loss, in patients expected to have a protracted ICU course to facilitate nursing care and decrease infection risk, and in those requiring the prone position later for procedures such as spinal surgery. 5,22,24 Patients with morbid obesity also tolerate subcutaneous devices better than an external fixator; the pelvic bridge has been suggested to be superior to the INFIX regarding its ease of application as the anatomic landmarks are identified more easily in obese patients. 5,22,24 Contraindications include pure ligamentous dislocation at the pubic symphysis or iliac wing dislocations; severe degloving soft tissue injuries or active infection in the suprapubic or iliac crest areas; open pelvic fractures with peritoneal contamination; pregnancy; and haemodynamically unstable pelvic ring injuries requiring rapid stabilisation for life-saving reasons.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly: case report and literature review

Strydom

Snyckers²

2021

SA orthop. j.

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BACKGROUND: As our population ages, the incidence of pelvic fragility fractures will rise accordingly. Despite these fractures having similar mortality rates to proximal femur fractures, there exist discrepancies between the management of these injuries. Although a number of pelvic fragility fractures can be treated successfully with conservative means, early treatment with appropriate surgical means should be considered in those failing conservative treatment or with unstable fracture patterns. CASE REPORT: We present an 84-year-old female who sustained a pelvic fragility fracture after a low-energy fall. Despite adequate conservative treatment, she was unable to mobilise. She was taken for anterior and posterior fixation, using our modified minimally invasive subcutaneous technique (the Bridging Infix) for anterior fixation. At the six-week follow-up she had regained full independent mobility. She had three syncope-related falls during this period, but radiographs revealed no sign of implant displacement. One year after her surgery she had complete union of her fracture, good function and no desire to have the implant removed. DISCUSSION: With the expected increase in pelvic fragility fractures due to the growing elderly population, our understanding of these injuries has begun to change. Occult posterior ring injuries have been described in up to 80% of cases, while fracture progression to unstable patterns can occur in up to 15% of stable patterns. Despite conservative management being the primary treatment of choice, these patients suffer morbidity and mortality rates comparable to proximal femur fractures. Early appropriate surgical management should be considered in patients failing to mobilise. Various surgical techniques have been described, each with their own advantages and disadvantages. Newer minimally invasive techniques are gaining favour, especially for use in elderly patients. These constructs combine the low profile benefits of internal plate fixation with ex-fix principles. CONCLUSION: The Bridging Infix is a modified technique for minimally invasive subcutaneous anterior pelvic fixation. Its use can strongly be considered by even the general orthopaedic surgeon in cases where patients are too frail for extensive or invasive surgeries, such as open reduction and internal fixation with plate and screws. Level of evidence: Level 5 Keywords: pelvic fracture, anterior pelvic fixation, elderly, minimally invasive

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly: case report and literature review

Strydom

Snyckers²

2021

SA orthop. j.

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Subcutaneous anterior pelvic bridge — an innovative technique for fixation of selective acetabular fracture: a case series and literature review

Chen

Lien

2022

International Orthopaedics (SICOT)

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Introduction The aim of the study was to introduce an innovative technique involving the use of a subcutaneous anterior pelvic bridge (SAPB) in the treatment of selective acetabular fractures. Methods We performed a retrospective study of 21 patients with acetabular fracture who were treated with SAPB between January 2016 and March 2021. The patients’ data were retrieved from electronic charts. Radiological results were evaluated according to the Matta system to assess the quality of the reduction and time of union. Functional outcomes were assessed in line with the d’Aubigné and Postel scoring system. Post-operative complications were also recorded. Results SAPB required around 60 minutes, with minimal blood loss and short learning curve. Matta score revealed excellent radiological outcomes in seventeen displaced fractures with seven excellent outcomes and nine good outcomes. Functional outcomes were excellent in twelve hips, good in seven hips, and fair in two hips. Six patients had transient lateral femoral cutaneous nerve palsy. Discussion The innovative SAPB method for the treatment of selective acetabular fracture is proven to be a feasible method with promising outcomes. SAPB is a minimally invasive technique and strengthens the stability of fixation, with less blood loss and fewer intra-operative/post-operative complications.

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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

Patel

Aggarwal

Jindal

et al. 2021

Arch Orthop Trauma Surg

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The Pelvic Bridge

Cited by 7 publications

References 4 publications

Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly: case report and literature review

Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly: case report and literature review

Subcutaneous anterior pelvic bridge — an innovative technique for fixation of selective acetabular fracture: a case series and literature review

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

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