Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2023; 14(7): 562-571
Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.562
Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study
Mohamed Abo-Elsoud, Mostafa I Awad, Mahmoud Abdel Karim, Sherif Khaled, Mohamed Abdelmoneim
Mohamed Abo-Elsoud, Mahmoud Abdel Karim, Sherif Khaled, Mohamed Abdelmoneim, Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
Mostafa I Awad, Department of Trauma and Orthopedics, Mataria Teaching Hospital, Cairo 4540046, Egypt
Author contributions: All authors have contributed to design of the study, surgical intervention, patients assessment and follow up, manuscript writing and editing.
Institutional review board statement: The study was approved by the ethical committee of faculty of medicine, Cairo university on 8/12/2018 with the number “N-147-2023”.
Clinical trial registration statement: This is not an RCT it wasn’t registered on clinical trial .gov.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors confirm that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mahmoud Abdel Karim, MD, PhD, Professor, Department of Orthopedics and Traumatology, Cairo University Hospitals, Kasr Al-Ainy Street, Cairo 11562, Egypt. mabdelkarim@hotmail.com
Received: December 28, 2022
Peer-review started: December 28, 2022
First decision: April 13, 2023
Revised: April 14, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: July 18, 2023
Abstract
BACKGROUND

Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture.

AIM

To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries.

METHODS

A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score.

RESULTS

The results revealed a statistically significant difference between both groups (P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group (P = 0.513). A lower surgical site infection rate was noticed in the INFIX group (P = 0.007).

CONCLUSION

Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.

Keywords: Internal fixator, External fixator, Unstable, Anterior, Pelvic, Injuries

Core Tip: Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injures is considered to be a great step to efficiently reduce the mortality rate associated with these types of injures. There is a debate on the use of either anterior subcutaneous pelvis internal fixator (INFIX) or anterior supra-acetabular external fixator (EXFIX) in the management of anterior unstable pelvic ring fracture. This study aimed to compare the functional, radiological outcomes as well as complications of INFIX vs EXFIX in management of unstable pelvic ring injuries. This study showed that anterior subcutaneous pelvis INFIX is associated with better radiological outcome and less rate of infection than anterior supra-acetabular EXFIX in management of patients with anterior unstable pelvic ring fractures.