Thurs., 10/8/09 Pelvis & Acetabulum, Paper #36, 4:33 pm OTA-2009
A Clinical Comparison between Anterior Pelvic External Fixation and Subcutaneous Locked Pelvic Spanning Internal Fixation for Pelvic Ring Injuries
Archie A. Heddings, MD1 (n); Jack Anavian, MD2 (n); Thuan V. Ly, MD2 (n);
Robert A. Morgan, MD2 (n); Peter A. Cole, MD2 (5B, 7-Synthes; Zimmer; Smith &Nephew; DePuy, A Johnson &Johnson Company; Acumed, LLC; Biomet);
1Department of Orthopaedic Surgery, University of Kansas Medical Center,
Kansas City, Kansas, USA;
2Department of Orthopaedic Surgery, University of Minnesota-Regions Hospital,
Saint Paul, Minnesota, USA
Purpose: The anterior pelvic external fixator (APEF) is a time-tested, quick, and reliable method to render stability to an unstable pelvic ring. However, APEF treatment has been demonstrated to be associated with frequent complications including pin-tract infections, patient dissatisfaction, loosening, and interference with surgical procedures. A novel technique was developed, a subcutaneous pelvic-spanning internal fixator (PSIF), which could potentially address some of these issues. The purpose of the present study is to retrospectively review and compare 2 patient cohorts treated with external versus internal fixators, respectively, for pelvic ring injuries.
Methods: 46 consecutive patients were treated with either an APEF (n = 23) or a subcutaneous PSIF (n = 23) for a pelvic ring injury between 2005 and 2008. There were no significant differences between the 2 groups with respect to pelvic fracture pattern or treatment rendered for the posterior pelvic lesion. Measurements for anterior-posterior (inlet films) and cephalad-caudad (outlet films) displacement were taken at injury, after fixation, at implant removal, and at follow-up. The Student t test was used to compare the groups with regard to displacement. Postoperative complications, including infections, pain at surgical site, fixation failure, nonunions, and revision surgery, were recorded.
Results: The mean ISS scores were 21 (range, 5-48) for the PSIF group and 24 (range, 10-41) for the APEF group. At a mean follow-up of 9.8 months (range, 3-25) for the PSIF and 8.0 months (range, 2-29) for the APEF group, all but 1 patient (PSIF) had bony union of their fractures with acceptable pelvic alignment. There was no significant difference between the 2 groups with regard to displacement and change in deformity, perioperatively. Complications for the PSIF group (17%) included transient thigh parathesias that resolved in 2 patients, a superficial wound infection in 1 patient, and revision surgery for nonunion of a ramus fracture in 1 patient. There was no surgical-site pain in this group. Complications for the APEF group included superficial pin-site infections (n = 8, 35%), persistent pin-site pain (n = 4, 17%), and revision surgery for fixation failure (n = 3, 13%).
Conclusion: Based on the initial experience with PSIF, encouraging clinical results were demonstrated, including adequate fixation with lower morbidity, wound complications, and less surgical-site pain when compared to APEF. Further study and analysis of this technique is warranted to determine if strong recommendations can be made in favor of this fixation modality.
• 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