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Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

  • Symposium: Disruptions of the Pelvic Ring: An Update
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis.

Description of Technique

An incision is made over each anterior iliac crest and a 6- to 8-cm incision is centered over the symphysis. Either a locking reconstruction plate or a spinal rod is placed through a subcutaneous tunnel overlying the external oblique fascia in the subcutaneous tissue, and fixation into the iliac crest and pubis is achieved to effect stability.

Methods

A randomized controlled trial comparing anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) for unstable pelvic ring injuries was begun in October 2010. Patients with unstable pelvic ring injuries were enrolled and followed with respect to fracture reduction, surgical pain, complications, and functional outcome scores.

Results

As of January 2012, 23 patients met inclusion; however, 12 patients refused participation because of the possibility of external fixation, leaving 11 patients (four male, seven female) enrolled. At 6-month followup, there was a single pin tract infection in the APEF cohort and no complications or pain in the APIF cohort.

Conclusions

This clinical experience lends support to the use of a new minimally invasive technique to stabilize the anterior pelvis, particularly given the resistance on the part of patients to consider external fixation.

Level of Evidence

Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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References

  1. Barei DP, Shafer BL, Beingessner DM, Gardner MJ, Nork SE, Routt ML. The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma. 2010;68:949–953.

    PubMed  Google Scholar 

  2. Cole PA, Gauger EM, Anavian J, Ly TV, Morgan RA, Heddings AA. Anterior Pelvic External Fixator Versus Subcutaneous Internal Fixator in the Treatment of Anterior Ring Pelvic Fractures. J Orthop Trauma. 2012 February 21 [Epub ahead of print].

  3. Dienstknecht T, Berner A, Lenich A, Nerlich M, Fuechtmeier B. A minimally invasive stabilizing system for dorsal pelvic ring injuries. Clin Orthop Relat Res. 2011;469:3209–3217.

    Article  PubMed  Google Scholar 

  4. Doklamyai P, Agthong S, Chentanez V, Huanmanop T, Amarase C, Surunchupakorn P, Yotnuengnit P. Anatomy of the lateral femoral cutaneous nerve related to inguinal ligament, adjacent bony landmarks, and femoral artery. Clin Anat. 2008;21:769–774.

    Article  PubMed  Google Scholar 

  5. Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27(suppl 1):SA13–SA20.

    Google Scholar 

  6. Gardner MJ, Mehta S, Mirza A, Ricci WM. Anterior Pelvic Reduction and Fixation Using a Subcutaneous Internal Fixator. J Orthop Trauma. 2011 October 28 [Epub ahead of print].

  7. Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein J, Panetta T, Shaftan G. Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma. 1986;26:325–333.

    Article  PubMed  CAS  Google Scholar 

  8. Gylling SF, Ward RE, Holcroft JW, Bray TJ, Chapman MW. Immediate external fixation of unstable pelvic fractures. Am J Surg. 1985;150:721–724.

    Article  PubMed  CAS  Google Scholar 

  9. Haidukewych GJ, Kumar S, Prpa B. Placement of half-pins for supra-acetabular external fixation: an anatomic study. Clin Orthop Relat Res. 2003;411:269–273.

    Article  PubMed  Google Scholar 

  10. Kellam JF. The role of external fixation in pelvic disruptions. Clin Orthop Relat Res. 1989;241:66–82.

    PubMed  Google Scholar 

  11. Kim WY, Hearn TC, Seleem O, Mahalingam E, Stephen D, Tile M. Effect of pin location on stability of pelvic external fixation. Clin Orthop Relat Res. 1999;361:237–244.

    Article  PubMed  Google Scholar 

  12. Korovessis P, Stamatakis M, Baikousis A. Posterior stabilization of unstable sacroiliac injuries with the Texas Scottish Rite Hospital spinal instrumentation. Orthopedics. 2000;23:323–327.

    PubMed  CAS  Google Scholar 

  13. Kuttner M, Klaiber A, Lorenz T, Fuchtmeier B, Neugebauer R. [The pelvic subcutaneous cross-over internal fixator] [in German]. Unfallchirurg. 2009;112:661–669.

    Article  PubMed  CAS  Google Scholar 

  14. Lindahl J, Hirvensalo E, Bostman O, Santavirta S. Failure of reduction with an external fixator in the management of injuries of the pelvic ring: long-term evaluation of 110 patients. J Bone Joint Surg Br. 1999;81:955–962.

    Article  PubMed  CAS  Google Scholar 

  15. Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36:599–604.

    Article  PubMed  CAS  Google Scholar 

  16. Moazzam C, Heddings A, Moodie P, Cole P. Anterior Pelvic Subcutaneous Internal Fixator Application: An Anatomic Study. J Orthop Trauma. 2012 February 14 [Epub ahead of print].

  17. Palmer S, Fairbank AC, Bircher M. Surgical complications and implications of external fixation of pelvic fractures. Injury. 1997;28:649–653.

    Article  PubMed  CAS  Google Scholar 

  18. Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33:329–338.

    Article  PubMed  CAS  Google Scholar 

  19. Pohlemann T, Bosch U, Gansslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res. 1994;305:69–80.

    Article  PubMed  Google Scholar 

  20. Ponsen KJ, Joosse P, Van Dijke GA, Snijders CJ. External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins. Acta Orthop. 2007;78:648–653.

    Article  PubMed  Google Scholar 

  21. R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2009.

    Google Scholar 

  22. Riemer BL, Butterfield SL, Diamond DL, Young JC, Raves JJ, Cottington E, Kislan K. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma. 1993;35:671–675; discussion 676–677.

    Article  PubMed  CAS  Google Scholar 

  23. Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop Relat Res. 2000;375:15–29.

    Article  PubMed  Google Scholar 

  24. Routt ML Jr, Simonian PT. Internal fixation of pelvic ring disruptions. Injury. 1996;27(suppl 2):B20–B30.

    PubMed  Google Scholar 

  25. Routt ML Jr, Simonian PT, Swiontkowski MF. Stabilization of pelvic ring disruptions. Orthop Clin North Am. 1997;28:369–388.

    Article  PubMed  Google Scholar 

  26. Sagi HC, Coniglione FM, Stanford JH. Examination under anesthetic for occult pelvic ring instability. J Orthop Trauma. 2011;25:529–536.

    Article  PubMed  Google Scholar 

  27. Simonian PT, Routt ML Jr. Biomechanics of pelvic fixation. Orthop Clin North Am. 1997;28:351–367.

    Article  PubMed  CAS  Google Scholar 

  28. Starr AJ, Nakatani T, Reinert CM, Cederberg K. Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop Trauma. 2008;22:81–87.

    Article  PubMed  Google Scholar 

  29. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70:1–12.

    PubMed  CAS  Google Scholar 

  30. Tucker MC, Nork SE, Simonian PT, Routt ML Jr. Simple anterior pelvic external fixation. J Trauma. 2000;49:989–994.

    Article  PubMed  CAS  Google Scholar 

  31. Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: Initial clinical series. J Orthop Trauma. 2012;26:1–8.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Aaron R. Jacobson DC for help with preparation of the manuscript and useful comments

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, 640 Jackson Street, St Paul, MN, 55101-2595, USA

    Timothy G. Hiesterman DO, Brian W. Hill MD & Peter A. Cole MD

Authors
  1. Timothy G. Hiesterman DO
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  2. Brian W. Hill MD
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  3. Peter A. Cole MD
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Corresponding author

Correspondence to Peter A. Cole MD.

Additional information

The institution of one or more of the authors (TGH, BWH, PAC) has received, in any 1 year, funding for unrelated research from Synthes USA (Paoli, PA, USA) and Zimmer Inc (Warsaw, IN, USA). Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Hiesterman, T.G., Hill, B.W. & Cole, P.A. Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge. Clin Orthop Relat Res 470, 2116–2123 (2012). https://doi.org/10.1007/s11999-012-2341-4

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  • DOI: https://doi.org/10.1007/s11999-012-2341-4

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