The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator

Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study

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.

Pathologic Pubic Symphysis Diastasis in Pregnant Pelvic Ring Fracture Treated with INFIX: A Case Report

CASE

Unstable pelvic ring fractures in pregnancy are an uncommon injury. Successful treatment of these patients with an INFIX device is even less common, with sparse literature to document the patient outcomes. We found no literature documenting the acute management of a pregnant patient with an INFIX device with (1) dynamic changes recorded, such as increasing pubic symphysis diastasis, and (2) restoration of normal symphyseal anatomy after birth and INFIX removal.

CONCLUSION

Use of a pelvic INFIX during pregnancy allowed functional independence. The construct offered sufficient stability while also allowing for pubic symphysis diastasis. After parturition, she returned to normal function with no injury sequela.

Stability of internal versus external fixation in osteoporotic pelvic fractures - a biomechanical analysis

INTRODUCTION

Osteoporosis-related fragility fractures of the pelvic ring (FFP) differ fundamentally from pelvic fractures in younger patients. However, very little is known about biomechanical stability of different osteosynthesis procedures addressing the anterior pelvic ring in these fractures. The aim of this study was to compare standard external fixation with internal fixation using a novel screw-and-rod system in osteoporotic fractures of the pelvic ring in terms of stiffness, plastic deformation and maximum load under cyclic loading in a human cadaveric model.

MATERIALS AND METHODS

A total of 18 embalmed osteoporotic cadaver pelvis specimens were randomized based on the T-score into a group for external fixation and a group for internal fixation. FFP type-IIB fractures were created. In addition to the external or internal fixator, a cement-augmented sacroiliac screw was implanted. Afterwards, axial cyclic loading was performed in a testing setup simulating one-leg stand.

RESULTS

Mean plastic deformation and stiffness both were significantly better in the internal fixation group than in the external fixation group (plastic deformation: 0.37 mm (SD: 0.23) versus 0.71 mm (SD: 0.26), p = 0.011; stiffness: 43.69 N/mm (SD: 18.39) versus 26.52 N/mm (SD: 9.76), p = 0.029). Maximum load did not differ significantly between internal fixator (506.3 N; SD: 129.4) and external fixator (461.1 N; SD: 147.4) (p = 0.515).

CONCLUSIONS

Submuscular internal fixation might be an interesting alternative to external fixation in clinical practice because of better biomechanical properties as well as several advantages in clinical use.

Relative position of the supra-acetabular bone to the crestal plane: a radiological analysis

INTRODUCTION

Displaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments and in extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel.

METHODS

A radiological review of 50 randomised pelvic CT scans in European patients aged 18-30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined.

RESULTS

The supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin's entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side.

CONCLUSIONS

The supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon's thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.

External fixation of unstable pelvic fractures: a systematic review and meta-analysis

BACKGROUND

Unstable pelvic fractures are typically caused by high-impact trauma. Early stabilization is required to prevent further neurological or visceral injury, haemorrhage, reduce pain, infection and long-term deformity and disability. The aim was to review the optimal external fixation techniques and management for unstable pelvic fractures.

METHODS

A total of 28 studies were identified from the initial database search. Seventeen studies met our inclusion criteria - eight prospective cohorts, four retrospective cohorts and five in vitro studies. This equated to 539 patients and 38 cadaveric (in vitro) models.

RESULTS

Type B and double vertical fractures have less re-displacement (43.7% and 68.2% <5 mm, respectively) than Type C fractures (55.7% >15 mm) regardless of pin placement. Greater than 50% experience a complication with the most common being pin site infection (36%) and a trend towards increased infection with increasing pins was seen. Most can be managed with antibiotics alone (93%). A minimum time of 6-8 weeks in frame was required for definitive management of all fractures.

CONCLUSION

This review supports the use of supra-acetabular pins over iliac crest pins to decrease re-displacement, the least number of pins for the shortest amount of time and the largest size pin where possible. Type B fractures will generally have a better outcome than Type C fractures. Definitive management in a frame should be at least 8 weeks. Further studies directly comparing iliac crest and supra-acetabular pin placement are recommended.

Patient Weight-bearing after Pelvic Fracture Surgery-A Systematic Review of the Literature: What is the Modern Evidence Base?

Background

Little attention in the literature appears to have been paid to the issue of postoperative weight-bearing protocols for different injury patterns after pelvic fracture surgery. The primary aim of this study is to review the currently available literature to define the level of available evidence used to inform surgical decisions on weight-bearing after pelvic fracture surgery. Secondary aims are to assess the published methods of fracture classification, surgical management, and assessment or reporting of patient outcomes.

Methods

A systematic review of the English language literature from 1990 to 2016 was undertaken. Eligible papers were all papers reporting minimum 6-month outcomes following surgery for pelvic fractures in adults. Exclusion criteria included pathological fractures or those resulting from penetrating injury, solely osteoporotic fractures, or series with less than 6 months of follow-up data.

Results

There is very little published scientific data to inform the treating surgeon on postoperative weight-bearing protocols after pelvic fracture surgery, with no randomized trials and only 1 paper out of 122 stating this as a primary aim. More than half of the papers published did not state what postoperative protocol was employed. There is no standardization of outcome measures, with less than 20% of papers using the most common validated outcome scoring system; in contrast, there is good agreement on the use of either the Tile (75%) or Burgess and Young (20%) classification.

Limitations

Due to the lack of published studies looking at the topic of postoperative weight-bearing after pelvic fractures, no specific recommendations are possible. As large numbers of papers were included, they were not individually assessed for bias.

Conclusion

A review of postoperative weight-bearing regimes reveals a nonexistent scientific evidence base from which to make recommendations, although a consensus strategy has been identified. Future research needs to be directed at this topic, as has already been the case in numerous other fracture areas, since the advantages of early mobility are potentially significant. The reported methodology for assessing and reporting patient outcomes after pelvic fracture surgery reveals no consistent standards, and the majority of papers use no specific outcome scoring system.

How to cite this article

Rickman M, Link B-C, Solomon LB. Patient Weight-bearing after Pelvic Fracture Surgery-A Systematic Review of the Literature: What is the Modern Evidence Base? Strategies Trauma Limb Reconstr 2019;14(1):45-52.

Anterior Subcutaneous Internal Pelvic Fixation/INFIX: A Systemic Review

INTRODUCTION

The purpose of this article is to review the available literature on anterior subcutaneous internal pelvic fixation (ASIPF) to identify indications, clinical and radiographic outcomes, and compare these with alternative fixation methods.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search on PubMed and Google Scholar was performed. Articles included were in the English language or English translations and published between 2007 and 2018. Studies included were appraised with narrative data synthesis.

RESULTS

Twenty-five articles with 496 patients were included. These included 17 case series, with 3 case reports reporting adverse events.

CONCLUSIONS

ASIPF and the appropriate posterior fixation resulted in healing of pelvic ring injuries in 99.5% of cases. Indications include unstable pelvic ring injuries with the appropriate posterior fixation. Radiographic parameters and outcome measures were infrequently reported. ASIPF is a valuable tool for reduction and fixation in unstable pelvic ring injuries. Complications include lateral femoral cutaneous nerve irritation (26.3%); heterotopic ossification (36%); infection (3%); and femoral nerve palsy (1%), which is likely related to placing the bar and screws too deep.

Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries

OBJECTIVE

To describe our experience using the anterior internal pelvic fixator (INFIX) for treating pelvic ring injuries.

DESIGN

Case Series.

SETTING

Level 1 Trauma Center.

PATIENTS

Eighty-three patients with pelvic ring injuries were treated with INFIX. Follow-up average was 35 months (range 12-80.33).

INTERVENTION

Surgical treatment of pelvic ring injuries included reduction, appropriate posterior fixation, and INFIX placement.

OUTCOME MEASUREMENTS

Reduction using the pelvic deformity index and pubic symphysis widening, Majeed functional scores, complications; infection, implant failure, heterotopic ossification (HO), nerve injury, and pain.

RESULTS

All patients healed in an appropriate time frame (full weight bearing 12 weeks postoperation). The average pelvic deformity index reduction (injury = 0.0420 ± 0.0412, latest FU = 0.0254 ± 0.0243) was 39.58%. The average reduction of pubic symphysis injuries was 56.92%. The average Majeed score of patients at latest follow-up was 78.77 (range 47-100). Complications were 3 infections, 1 case of implant failure, 2 cases implantation too deep, 7 cases of lateral femoral cutaneous nerve irritation, and 3 cases of pain associated with the device. HO was seen in >50% of the patients, correlated with increased age (P < 0.007), injury severity score (P < 0.05) but only 1 case was symptomatic.

CONCLUSIONS

The pelvic injuries had good functional and radiological outcomes with INFIX and the appropriate posterior fixation. The downside is removal requiring a second anesthetic, there is a learning curve, HO often occurs, the lateral femoral cutaneous nerve may get irritated which often resolves once the implants are removed. Surgery-specific implants need to be developed.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Femoral nerve palsy after pelvic fracture treated with INFIX: a case series

OBJECTIVE

The treatment of some pelvic injuries has evolved recently to include the use of a subcutaneous anterior pelvic fixator (INFIX). We present 8 cases of femoral nerve palsy in 6 patients after application of an INFIX to highlight this potentially devastating complication to pelvic surgeons using this technique and discuss how it might be avoided in the future.

DESIGN

Retrospective chart review. Case series.

SETTING

Five level 1 and 2 trauma centers, tertiary referral hospitals.

PATIENTS/PARTICIPANTS

Six patients with anterior pelvic ring injury treated with an INFIX who experienced 8 femoral nerve palsies (2 bilateral).

INTERVENTION

Removal of internal fixator, treatment for femoral nerve palsy.

MAIN OUTCOME MEASUREMENTS

Clinical and electromyographic evaluation of patients.

RESULTS

All 6 patients with a total of 8 femoral nerve palsies had their INFIX removed. Variable resolution of the nerve injuries was observed.

CONCLUSIONS

Application of an INFIX for the treatment of pelvic ring injury carries a potentially devastating risk to the femoral nerve(s). Despite early implant removal after detection of nerve injury, some patients had residual quadriceps weakness, disturbance of the thigh's skin sensation, and/or gait disturbance attributable to femoral nerve palsy at the time of early final follow-up.

LEVEL OF EVIDENCE

Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.

Internal anterior fixators for pelvic ring injuries: Do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws?

OBJECTIVES

Little is known about the mechanical properties of internal anterior fixators (known as INFIX), which have been proposed as subcutaneous alternatives to traditional anterior external fixators for pelvic ring disruptions. We hypothesised that INFIX has superior biomechanical performance compared with traditional external fixators because the distance from the bar to the bone is reduced.

METHODS

Using a commercially available synthetic bone model, 15 unstable pelvic ring injuries were simulated by excising the pubic bone through the bilateral superior and inferior rami anteriorly and the sacrum through the bilateral sacral foramen posteriorly. Three test groups were established: (1) traditional supra-acetabular external fixation, (2) INFIX with polyaxial screws, (3) INFIX with monaxial screws. Load was applied, simulating lateral compression force. Outcome measure was construct stiffness.

RESULTS

The traditional external fixator constructs had an average stiffness of 6.21 N/mm ± 0.40 standard deviation (SD). INFIX with monaxial screws was 23% stiffer than the traditional external fixator (mean stiffness, 7.66 N/mm ± 0.86 SD; p = .01). INFIX with polyaxial screws was 26% less stiff than INFIX with monaxial screws (mean stiffness, 5.69 N/mm ± 1.24 SD; p = .05). No significant difference was noted between polyaxial INFIX and external fixators (mean stiffness, 6.21 N/mm ± 0.40 SD; p=.65).

CONCLUSIONS

The performance of INFIX depends on the type of screw used, with monaxial screws providing significantly more stiffness than polyaxial screws. Despite the mechanical advantage of being closer to the bone, polyaxial INFIX was not stiffer than traditional external fixation.

Radiographic displacement in pelvic ring disruption: reliability of 3 previously described measurement techniques

BACKGROUND

The literature on pelvic ring disruptions is based largely on nonstandardized and nonvalidated radiographic outcomes. A thorough review of the literature revealed only 3 described methods for measuring radiographic displacement and 1 frequently used grading system for displacement. We aimed to test the reliability of these previously published radiographic measurement methods and grading system.

METHODS

Five separate observers measured radiographic displacement on the standardized pre- and postoperative anteroposterior, inlet, and outlet views of 25 patients with surgically treated Tile B and C pelvic fractures. The readers measured their initial impression based on the Tornetta and Matta grading system (excellent, good, fair, and poor). Next, they measured displacement using the inlet and outlet ratio as described by Sagi, the cross measurement technique as described by Keshishyan, and the absolute displacement method (ADM) as described by Lefaivre. The millimeter measurement obtained by the ADM was converted using the Tornetta and Matta grading system. Each continuous measure was compared for interobserver reliability using intraclass correlations (ICCs), and the categorical outcomes were compared using a kappa statistic. Finally, the relationship of the initial impression to the grade as determined by the ADM was compared using kappa agreement.

RESULTS

The agreement among observers based on initial impression was poor (kappa statistic, 0.306) but was fair among those reductions that were excellent (κ = 0.495). Using the Sagi method, the reliability ICC was moderate for the postoperative inlet [0.515, 95% confidence interval (CI), 0.338-0.702] and outlet ratio (0.594, 95% CI, 0.423-0.760) but almost perfect in preoperative radiographs (inlet: 0.814, 95% CI, 0.703-0.901; outlet: 0.863, 95% CI, 0.775-0.929). The ICCs for all interpretations of the Keshishyan technique were excellent but were highest when considered as a ratio (preoperative: 0.938, 95% CI, 0.894-0.969; postoperative: 0.912, 95% CI, 0.850-0.955). Using the ADM, the location and film used for measurement had poor agreement, and the ICC for the measurement in millimeters was moderate (preoperative: 0.522, 95% CI, 0.342-0.708; postoperative: 0.432, 95% CI, 0.255-0.634) and the kappa agreement poor when converted using the Tornetta and Matta scale (κ = 0.2190). The agreement between the impression and the converted grade from the ADM was poor (κ = 0.2520).

CONCLUSIONS

Radiographic measurement in pelvic x-rays to date has been nonvalidated, and we found the interobserver reliability on common methods, including overall impression and absolute displacement in millimeters, to be poor. The inlet/outlet ratio as described by Sagi was reliable only with wide displacement. The cross measurement technique allows least observer choice and had excellent reliability but does not give a measurement that we can easily interpret based on convention in pelvic fracture description.

Methodology and interpretation of radiographic outcomes in surgically treated pelvic fractures: a systematic review

OBJECTIVE

To identify and evaluate previously described methods for the measurement, and interpretation, of radiographic outcomes of operatively treated pelvic fractures.

DATA SOURCES

A systematic review of the available literature was performed using all major databases (MEDLINE, EMBASE, MEDLINE IN-PROGRESS, and Cochrane Central) in August 2009.

STUDY SELECTION

Inclusion criteria were case series, cohort studies, or clinical trials regarding orthopaedic treatment of acute traumatic pelvic ring fractures treated surgically in adults, with at least 12 weeks of radiographic follow-up. Exclusion criteria were case reports or case series of <10 patients, review articles, foreign language articles, and series where time frame of outcome measurement was not stated were excluded.

DATA EXTRACTION

Modality, and timeline, of the radiographic assessment was recorded. Next, the description of the method of radiographic measurement technique used was scrutinized for standardization. The interpretation of the radiographic measurement was evaluated, and any grading scale used was recorded. The interpretation of the quality of the radiographic result as described by each author was recorded. Finally, a qualitative methodological analysis was performed.

DATA SYNTHESIS

Number of standardized radiographic assessment techniques used (3 of 31) and interpretation scales used (13 of 31) were calculated. Nonweighted mean follow-up time (30.6 months) and overall positive radiographic outcomes were calculated (78.6% good or excellent).

CONCLUSIONS

Reporting of radiographic outcomes in pelvic fractures has been done using largely unstandardized and universally untested measurement techniques. The interpretations of these measurements are also inconsistent and untested. Substantive future research is needed in this area.

Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study

BACKGROUND

Stabilization after a pelvic fracture can be accomplished with an anterior external fixator. These devices are uncomfortable for patients and are at risk for infection and loosening, especially in obese patients. As an alternative, we recently developed an anterior subcutaneous pelvic internal fixation technique (ASPIF).

QUESTIONS/PURPOSES

We asked if the ASPIF (1) allows for definitive anterior pelvic stabilization of unstable pelvic injuries; (2) is well tolerated by patients for mobility and comfort; and (3) has an acceptable complication rate.

METHODS

We retrospectively reviewed 91 patients who incurred an unstable pelvic injury treated with an anterior internal fixator and posterior fixation at four Level I trauma centers. We assessed (1) healing by callous formation on radiographs and the ability to weightbear comfortably; (2) patient function by their ability to sit, stand, lie on their sides, and how well they tolerated the implants; and (3) complications during the observation period. The minimum followup was 6 months (mean, 15 months; range, 6-40 months).

RESULTS

All 91 patients were able to sit, stand, and lie on their sides. Injuries healed without loss of reduction in 89 of 91 patients. Complications included six early revisions resulting from technical error and three infections. Irritation of the lateral femoral cutaneous nerve was reported in 27 of 91 patients and resolved in all but one. Heterotopic ossification around the implants, which was asymptomatic in all cases, occurred in 32 of 91 patients.

CONCLUSIONS

The anterior internal fixator provided high rates of union for the anterior injury in unstable pelvic fractures. Patients were able to sit, stand and ambulate without difficulty. Infections and aseptic loosening were reduced but heterotopic ossification and irritation of the LFCN are common.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Anterior pelvic reduction and fixation using a subcutaneous internal fixator

Acute traumatic pelvic instability mandates reduction and mechanical stabilization to maximize the chance of a good functional outcome. Posterior pelvic fixation is frequently inadequate to stabilize the pelvic ring in isolation. Fixation augmentation with anterior pelvic ring implants can take several forms, including plates, medullary screws, or external fixation. Based on a multitude of patient and injury factors, external fixation may be the definitive anterior pelvic implant of choice. However, many drawbacks exist with this treatment, most notably the high infection rates of the transcutaneous pins, impaired patient mobilization, and suboptimal mechanical properties. We present a technique of a subcutaneous anterior pelvic fixator as an alternative method of anterior pelvic ring reduction and stabilization that avoids many of the drawbacks of traditional anterior pelvic external fixation.

Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame

We describe our early operative experience with a new pelvic reduction frame and the standard of reduction of fractures of the pelvic ring which we achieved in the first 35 consecutive patients, with 34 acute fractures and one nonunion. The pre-operative and immediate post-operative radiographs were measured, using two methods, to find the maximum radiological displacement of the fracture and the quality of the reduction according to the criteria of Tornetta and Matta. There were 19 vertical shear fractures and 16 compression injuries. The mean age of the patients was 33.5 years (10 to 59) and mean delay to surgery was 4.6 days (0 to 16) in the 34 acute injuries. The mean operative time in isolated procedures was 103.4 minutes (SD 6.5). All but one patient had iliosacral screws implanted, 18 had screws in the anterior column, six had plates at the symphysis pubis and 12 had anterior external fixators. The mean maximum horizontal or vertical displacement was improved from 30.8 mm (SD 2.7) to a mean of 7.1 mm (SD 0.7). The reduction was assessed as excellent in ten patients, good in 18, and fair in the remainder. There was no significant influence on the quality of the reduction caused by obesity (p = 0.34), the type of fracture (p = 0.41) or delay to surgery (p = 0.83). The frame was shown to be effective, allowing the surgeon to obtain a satisfactory reduction and fixation of acute displaced disruptions of the pelvic ring.

Fehleinschätzung bei vorderer Beckenringfraktur im höheren Lebensalter

Clinical outcome following pelvic ring fractures of AO/OTA type-A in the elderly is often unsatisfying because the posterior pelvic ring fracture is underdiagnosed and patients with type B fractures were conservatively treated like patients with type A fractures. This so-called "A-B" problem was systematically analyzed in our patients with pelvic ring fractures. 183 patients were treated with pelvic ring fractures. Primarily, the injuries were classified as follows: 81 type A, 38 type B, and 64 type C. The diagnosis was changed from type A to type B injury in seven patients. Parameters of investigation included fracture type, duration of symptoms, treatment, and outcome score according to the German Multicenter Study Group Pelvis. Persistent pain in the sacral area over an average of 2 (1-6) weeks was found in all patients. The CT scan revealed in all patients a transalar sacral impression fracture in the sense of an internal rotationally unstable injury of type AO/OTA B 2.1. The treatment consisted in a supra-acetabular external fixator for an average of 3 weeks. After 4 weeks the mean pelvis outcome score was 9 (7-10) points. In cases of persistent pain for more than 2 weeks after transpubic pelvic ring fractures in the elderly further investigation by CT scan should be recommended to exclude a concomitant sacral fracture, which then could be safely treated by a supra-acetabular external fixator.

Complications of temporary and definitive external fixation of pelvic ring injuries

OBJECTIVES

To determine the incidence of complications of external fixation in pelvic ring injuries, comparing fixator use for temporary and definitive treatment.

DESIGN

Retrospective case-note review.

SETTING

A regional centre for pelvic trauma in the UK.

PATIENTS

100 consecutive patients.

INTERVENTION

All patients were treated with pelvic external fixation for a pelvic ring injury.

RESULTS

In 52 patients, external fixation was intended for use as the definitive treatment of the pelvic ring injury and was maintained for a mean duration of 60 days (17-113). In 48 patients, it was used temporarily for a mean duration of 8 days (1-20) before internal fixation of the pelvic ring. The complication rate for definitive and temporary fixators was 62 and 21%, respectively. Pin-site infection occurred in 50% of definitive fixators and 13% of temporary fixators but rarely led to more serious complications. In five patients, the definitive management was changed as a result of a complication of the external fixator. The commonest cause for revision of either fixator was aseptic pin loosening. Revision for loose pins in eight patients was associated with the use of two pins in each iliac crest rather than three.

CONCLUSIONS

The temporary use of external fixation is safe and effective, but use for definitive treatment is associated with a high rate of infection and aseptic pin loosening.