Thurs., 10/8/09 Pelvis & Acetabulum, Paper #35, 4:27 pm OTA-2009
•Minimally Invasive Treatment of Unstable Pelvic Ring Injuries with an Internal Anterior Fixator (INFIX) and Posterior Iliosacral Screws
Rahul Vaidya, MD (n); Frederick Tonnos, DO (n); Robert Colen, DO (n); Anil Sethi, MD (n);
Detroit Medical Center Detroit Receiving Hospital, Detroit, Michigan, USA
Purpose: The purpose of this paper is to present a novel technique of anterior fixation of unstable pelvic fractures that is minimally invasive, biomechanically sound, easy to apply, and uses readily available spinal implants.
Methods: 21 consecutive patients with an unstable pelvic fractures (14 A and 7 B AO classification) underwent stabilization using the novel technique of fixation and were included in the study. Two trauma-trained orthopaedic surgeons performed all the procedures. All patients were evaluated clinically and with imaging studies that included AP, inlet, and outlet radiographs and a CT scan. At surgery, the posterior instability was addressed first with iliosacral screw fixation following reduction of the fracture in a standard fashion. A 2- to 3-cm longitudinal incision was then made over the anterior inferior iliac spine to obtain a starting point in the supra-acetabular region bilaterally. Pedicle screws of size 7 mm or 8 mm • 80 mm were then placed in the supra-acetabular position under fluoroscopic guidance. A precontoured 6-mm titanium rod with a bow was then tunneled subcutaneously to connect the screws. Care was taken to place the rod just below the lower abdominal crease to prevent pressure on the bowel or vascular structures below the inguinal ligament. The implants were compressed using standard compressors and c-rings and the hardware was tightened. Patients were followed until the pelvis fracture was clinically healed as documented on radiographs and clinical examination. The implants were scheduled to be removed at a minimum of 3 months postoperatively at a time when we felt the pelvic ring to be stable.
Results: Patients were followed for a minimum 6 months (range, 6-12 months). All patients healed by 3 months (similar to our prior experience using other methods). Complications included: 2 deaths unrelated to the pelvic procedure (in polytrauma patients), 2 patients with transient lateral femoral cutaneous nerve palsy (each on 1 side), and 1 early implant failure that was reoperated the next day related to surgeon technical error. Ten patients have had the implant removed at an average of 5 months postoperatively with no evidence of screw loosening and no implants have failed thus far.
Conclusions: Disruptions of the pelvic ring are complex injuries and should be managed on a case-specific basis. By employing the established principles of supra-acetabular fixation, this technique allows for minimally invasive, definitive internal anterior fixation. The potential complications of pin-tract infection and a cumbersome external appliance associated with external fixation are avoided with this technique and better patient acceptance is achieved.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant