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Complications of Anterior Subcutaneous Internal Fixation for Unstable Pelvis Fractures: A Multicenter Study

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

Abstract

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.

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Author information

Authors and Affiliations

  1. Detroit Medical Center, Wayne State University, 4D-4 University Health Center, Detroit Receiving Hospital, 4201 St Antoine Boulevard, Detroit, MI, 48201, USA

    Rahul Vaidya MD & Anil Sethi MD

  2. University of Utah, Salt Lake City, UT, USA

    Erik N. Kubiak MD

  3. Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA

    Patrick F. Bergin MD

  4. Parkland Memorial Hospital, Dallas, TX, USA

    Derek G. Dombroski MD

  5. Ortho Indy Methodist Hospital, Indianapolis, IN, USA

    Ren J. Critchlow MD

  6. Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Adam J. Starr MD

Authors
  1. Rahul Vaidya MD
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  2. Erik N. Kubiak MD
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  3. Patrick F. Bergin MD
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  4. Derek G. Dombroski MD
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  5. Ren J. Critchlow MD
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  6. Anil Sethi MD
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  7. Adam J. Starr MD
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Corresponding author

Correspondence to Rahul Vaidya MD.

Additional information

One of the authors (RV) is a consultant for Stryker Corporation to develop a commercial product related to the topic of this 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.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

This work was performed at the Detroit Medical Center, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA; University of Utah, Salt Lake City, UT, USA; Parkland Memorial Hospital, Dallas, TX, USA; and Ortho Indy Methodist Hospital, Indianapolis, IN, USA.

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Vaidya, R., Kubiak, E.N., Bergin, P.F. et al. Complications of Anterior Subcutaneous Internal Fixation for Unstable Pelvis Fractures: A Multicenter Study. Clin Orthop Relat Res 470, 2124–2131 (2012). https://doi.org/10.1007/s11999-011-2233-z

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  • DOI: https://doi.org/10.1007/s11999-011-2233-z

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