Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Xiao ^1,2 ,  WANG Qiang ³ , MA Yong ^1,2 , QIU Junjun ³ , ZHAO Lei ³ , SUI Jisheng ³ , NI Yan ³

1. Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, P.R.China;
2. Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, P.R.China;
3. Department of Orthopedics, Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210000, P.R.China;

Corresponding author：

WANG Qiang, Email: 13305162303@qq.com

Keywords：

Anterior pelvic ring fracture; unstable fracture; anterior subcutaneous internal fixator; plate; internal fixation

DOI：

10.7507/1002-1892.202006145

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Objective To compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures.Methods The clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation.Results The patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group (t=−11.965, P=0.000; t=−20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups (P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group (P>0.05), but there were significant differences in sitting and sexual intercourse scores (t=−4.250, P=0.003; t=−6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group (P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group (P<0.05).Conclusion Compared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.

Citation： YU Xiao, WANG Qiang, MA Yong, QIU Junjun, ZHAO Lei, SUI Jisheng, NI Yan. Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1555-1560. doi: 10.7507/1002-1892.202006145 Copy

1.	Chen W, Lv H, Liu S, et al. National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals. Lancet Glob Health, 2017, 5(8): e807-e817.
2.	Kuttner M, Klaiber A, Lorenz T, et al. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg, 2009, 112(7): 661-669.
3.	Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma, 2012, 26(1): 1-8.
4.	Matta JM, Tornetta P. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329): 129-140.
5.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
6.	Vaidya R, Martin AJ, Roth M, et al. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. Int Orthop, 2017, 41(8): 1671-1678.
7.	李勇, 艾名洋. 髂腹股沟微创切口接骨板内固定治疗骨盆前环骨折的临床效果及安全性分析. 中国当代医药, 2019, 26(19): 143-145.
8.	He Y, Lu Y, Yin B, et al. Numerical investigation on the biomechanical performance of laparoscopic-assisted plate used for fixing pelvic anterior ring fracture. J Healthc Eng, 2017, 2017: 9261037.
9.	Hanna A. The lateral femoral cutaneous nerve canal. J Neurosurg, 2017, 126(3): 927-978.
10.	Fang C, Alabdulrahman H, Pape HC. Complications after percutaneous internal fixator for anterior pelvic ring injuries. Int Orthop, 2017, 41(9): 1785-1790.
11.	周春奎. 骨盆骨折 INFIX 置钉入路的改良研究及其临床应用. 广州: 南方医科大学, 2019.
12.	马晓慧, 郑言言, 徐朝阳, 等. 股外侧皮神经在髂前上棘附近的解剖学和超声观察. 解剖学报, 2020, 51(3): 416-419.
13.	刘芳, 朱家安, 陈征. 股外侧皮神经超声探测方法学. 中国超声医学杂志, 2016, 32(9): 857-859.
14.	韩巍, 吴新宝, 姜钰, 等. 内置固定架治疗骨盆骨折致股神经麻痹三例. 中国修复重建外科杂志, 2016, 30(4): 523-524.
15.	Hesse D, Kandmir U, Solberg B, et al. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma, 2015, 29(3): 138-143.
16.	Hoskins W, Bucknill A, Wong J, et al. A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures. J Orthop Surg Res, 2016, 11(1): 135.
17.	Yin Y, Luo J, Zhang R, et al. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep, 2019, 9(1): 2578.
18.	梁羽, 钟凤林. 椎弓根钉棒系统治疗骨盆骨折九例. 海南医学, 2018, 29(22): 3205-3207.
19.	张堃, 米仲祥, 南学彦, 等. INFIX 治疗 Tile B 型骨盆骨折临床观察. 实用骨科杂志, 2018, 24(6): 550-552.
20.	Apivatthakakul T, Rujiwattanapong N. “Anterior subcutaneous pelvic internal fixator (INFIX), is it safe?” A cadaveric study Injury, 2016, 47(10): 2077-2080.
21.	Reichel LM, MacCormick LM, Dugarte AJ, et al. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX. Injury, 2018, 49(2): 309-314.
22.	Vaidya R, Kubiak EN, Bergin PF, et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res, 2012, 470(8): 2124-2131.

1. Chen W, Lv H, Liu S, et al. National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals. Lancet Glob Health, 2017, 5(8): e807-e817.
2. Kuttner M, Klaiber A, Lorenz T, et al. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg, 2009, 112(7): 661-669.
3. Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma, 2012, 26(1): 1-8.
4. Matta JM, Tornetta P. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329): 129-140.
5. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
6. Vaidya R, Martin AJ, Roth M, et al. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. Int Orthop, 2017, 41(8): 1671-1678.
7. 李勇, 艾名洋. 髂腹股沟微创切口接骨板内固定治疗骨盆前环骨折的临床效果及安全性分析. 中国当代医药, 2019, 26(19): 143-145.
8. He Y, Lu Y, Yin B, et al. Numerical investigation on the biomechanical performance of laparoscopic-assisted plate used for fixing pelvic anterior ring fracture. J Healthc Eng, 2017, 2017: 9261037.
9. Hanna A. The lateral femoral cutaneous nerve canal. J Neurosurg, 2017, 126(3): 927-978.
10. Fang C, Alabdulrahman H, Pape HC. Complications after percutaneous internal fixator for anterior pelvic ring injuries. Int Orthop, 2017, 41(9): 1785-1790.
11. 周春奎. 骨盆骨折 INFIX 置钉入路的改良研究及其临床应用. 广州: 南方医科大学, 2019.
12. 马晓慧, 郑言言, 徐朝阳, 等. 股外侧皮神经在髂前上棘附近的解剖学和超声观察. 解剖学报, 2020, 51(3): 416-419.
13. 刘芳, 朱家安, 陈征. 股外侧皮神经超声探测方法学. 中国超声医学杂志, 2016, 32(9): 857-859.
14. 韩巍, 吴新宝, 姜钰, 等. 内置固定架治疗骨盆骨折致股神经麻痹三例. 中国修复重建外科杂志, 2016, 30(4): 523-524.
15. Hesse D, Kandmir U, Solberg B, et al. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma, 2015, 29(3): 138-143.
16. Hoskins W, Bucknill A, Wong J, et al. A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures. J Orthop Surg Res, 2016, 11(1): 135.
17. Yin Y, Luo J, Zhang R, et al. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep, 2019, 9(1): 2578.
18. 梁羽, 钟凤林. 椎弓根钉棒系统治疗骨盆骨折九例. 海南医学, 2018, 29(22): 3205-3207.
19. 张堃, 米仲祥, 南学彦, 等. INFIX 治疗 Tile B 型骨盆骨折临床观察. 实用骨科杂志, 2018, 24(6): 550-552.
20. Apivatthakakul T, Rujiwattanapong N. “Anterior subcutaneous pelvic internal fixator (INFIX), is it safe?” A cadaveric study Injury, 2016, 47(10): 2077-2080.
21. Reichel LM, MacCormick LM, Dugarte AJ, et al. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX. Injury, 2018, 49(2): 309-314.
22. Vaidya R, Kubiak EN, Bergin PF, et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res, 2012, 470(8): 2124-2131.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures

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