Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.562
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
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 is one of the very few studies comparing the INFIX vs EXFIX in management of unstable anterior pelvic ring injuries.
The objective of this study was to compare the functional, radiological outcomes as well as complications of INFIX vs EXFIX in management of unstable pelvic ring injuries.
A prospective cohort study was carried including 54 patients with unstable pelvic ring fractures. The patients were divided into two groups: INFIX group in which 30 cases were fixed by INFIX and EXFIX group in which the 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. Evaluation of the radiological outcomes was done using Matta and Tornetta score and functional outcomes using Majeed score.
Fifty nine patients were recruited for the study; five were lost during follow-up. Fifty-four patients were left; 30 for the INFIX and 24 for the EXFIX groups. Operative time was shorter among the EXFIX group compared to the INFIX group (P < 0.001). INFIX group had significantly better quality of fracture reduction scores (P = 0.022). All fractures united by an average of 13 wk (range; 10-16 wk) (P = 0.536). Implants were removed in both groups starting at 3 mo postoperatively. Lateral femoral cutaneous nerve injury and infection were the most common complications reported. Infection was significantly higher among the EXFIX group (P = 0.007). Eight (33.4%) patients experienced pin-track infections that were classified according to Meléndez and Colón system. One patient had a severe surgical site infection (grade V) causing loosening of the pins and fixation failure after 2 wk. As regards the INFIX group, there was a single case (3.3%) of superficial infection that was treated by intravenous antibiotics and wound dressing. INFIX group was found to have significantly better Majeed scores in all modules. The total Majeed score had an average of 92.3 and 91 for the INFIX and the EXFIX groups, respectively.
This study suggests 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. Benefits of INFIX use include easiness to sit, stand and walk with the implant and low incidence of surgical site infection. On the other hand, operative time of EXFIX is shorter which makes it more suitable for emergency situations.
Further research studies that would have more sample size, and randomization of the patients (if feasible) are required.