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External Fixation in Pelvi-acetabular Implantology

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Handbook of Orthopaedic Trauma Implantology

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Abstract

External fixators represent one of the most versatile tools in the armamentarium of an orthopaedic surgeon. Modernization in the frame design and advancement in surgical techniques have broadened their scope of application, especially in pelvic injuries. A thorough understanding of the underlying biomechanical principles is, therefore, quite essential. One of the most important factors determining the fixation and pull out strength of a fixator construct is the design and diameter of the Schanz pin. In recent times, pedicle screw constructs in supra-acetabular configuration (InFix) are increasingly being tried as an alternative to traditional Schanz pin constructs. The insertion technique is minimally invasive and avoids problems associated with conventional pelvic external fixator frames. Despite their significant biomechanical advantage and ease of insertion, pelvic pedicle screw constructs have problems of rod insertion which can cause significant complications. The choice and configuration of a pelvic external fixation construct should therefore be tailored to an individual patient’s body habitus and injury profile in a targeted goal directed manner for optimal stabilization and fixation of an unstable pelvic injury.

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References

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

    Article  CAS  PubMed  Google Scholar 

  2. Gertzbein SD, Chenowith DR. Occult injuries of the pelvic ring. Clin Orthop Relat Res. 1977;128:202–7.

    Google Scholar 

  3. Vrahas M. Classification and bomechanics of pelvic ring injuries. Oper Tech Orthop. 1997;7(3):162–8.

    Article  Google Scholar 

  4. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987;18(1):25–41.

    CAS  PubMed  Google Scholar 

  5. Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma. 1989;29(7):981–1000; discussion 1000–1002.

    Article  CAS  PubMed  Google Scholar 

  6. Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S. Damage control orthopaedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers. Orthop Traumatol Surg Res. 2011;97(8):852–9.

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  8. Rieger H, Winckler S, Wetterkamp D, Overbeck J. Clinical and biomechanical aspects of external fixation of the pelvis. Clin Biomech (Bristol, Avon). 1996;11(6):322–7.

    Article  CAS  PubMed  Google Scholar 

  9. Pohlemann T, Tscherne H, Baumgartel F, Egbers HJ, Euler E, Maurer F, Fell M, Mayr E, Quirini WW, Schlickewei W, Weinberg A. Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. (German). Unfallchirurg. 1996;99:160–7.

    CAS  PubMed  Google Scholar 

  10. Elhence A. Internal fixation of pelvic injuries. J Orthop Traumatol Rehabil. 2014;7:19–22.

    Article  Google Scholar 

  11. Ponsen KJ, Hoek van Dijke GA, Joosse P, Snijders CJ. External fixators for pelvic fractures: comparison of the stiffness of current systems. Acta Orthop Scand. 2003;74(2):165–71.

    Article  PubMed  Google Scholar 

  12. Solomon LB, Pohl AP, Sukthankar A, Chehade MJ. The subcristal pelvic external fixator: technique, results, and rationale. J Orthop Trauma. 2009;23(5):365–9.

    Article  PubMed  Google Scholar 

  13. Lee C, Sciadini M. The use of external fixation for the management of the unstable anterior pelvic ring. J Orthop Trauma. 2018;32(Suppl 6):S14–7.

    Article  PubMed  Google Scholar 

  14. Carabalona P, Rabichong P, Bonnel F, Perruchon E, Peguret F. Apports du fixateur externe dans les dislocations du pubis et de l, articulation sacro-iliaque. Montpelier Chir. 1973;29:61.

    Google Scholar 

  15. Slätis P, Karaharju EO. External fixation of the pelvic girdle with a trapezoid compression frame. Injury. 1975;7(1):53–6.

    Article  PubMed  Google Scholar 

  16. Trikha V, Gupta H. Current management of pelvic fractures. J Clin Orthop Trauma. 2011;2(1):12–8.

    Article  Google Scholar 

  17. Tosounidis TH, Mauffrey C, Giannoudis PV. Optimization of technique for insertion of implants at the supra-acetabular corridor in pelvis and acetabular surgery. Eur J Orthop Surg Traumatol. 2018;28(1):29–35.

    Article  PubMed  Google Scholar 

  18. Bircher MD. Indications and techniques of external fixation of the injured pelvis. Injury. 1996;27(Suppl 2):B3–19.

    Article  PubMed  Google Scholar 

  19. Mears DC, Fu FH. Modern concepts of external skeletal fixation of the pelvis. Clin Orthop Relat Res. 1980;151:65–72.

    Google Scholar 

  20. Ponsen K-J, Joosse P, Van Dijke GAH, 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(5):648–53.

    Article  PubMed  Google Scholar 

  21. Behrens F. General theory and principles of external fixation. Clin Orthop Relat Res. 1989;241:15–23.

    Article  Google Scholar 

  22. Palmer RH, Hulse DA, Hyman WA, Palmer DR. Principles of bone healing and biomechanics of external skeletal fixation. Vet Clin North Am Small Anim Pract. 1992;22(1):45–68.

    Article  CAS  PubMed  Google Scholar 

  23. Thakur AJ. Chapter 8: External fixators. In: The elements of fracture fixation. 3rd ed. New Delhi: Elsevier; 2015. p. 316–27.

    Google Scholar 

  24. Willie B, Adkins K, Zheng X, Simon U. Claes mechanical characterization of external fixator stiffness for a rat femoral fracture model. J Orthop Res. 2009;27(5):687–93.

    Article  PubMed  Google Scholar 

  25. Moroni A, Pegreffi F, Cadossi M, Hoang-Kim A, Lio V, Giannini S. Hydroxyapatite-coated external fixation pins. Expert Rev Med Devices. 2005;2(4):465–71.

    Article  CAS  PubMed  Google Scholar 

  26. Magyar G, Toksvig-Larsen S, Moroni A. Hydroxyapatite coating of threaded pins enhances fixation. J Bone Joint Surg Br. 1997;79(3):487–9.

    Article  CAS  PubMed  Google Scholar 

  27. Kuttner M, Klaiber A, Lorenz T, Fuchtmeier B, Neugebauer R. The pelvic subcutaneous cross- over internal fixator. Der Unfallchirug. 2009;112(7):661–9.

    Article  CAS  Google Scholar 

  28. Reichel LM, MacCormick LM, Dugarte AJ, Rizkala AR, Graves SC, Cole PA. Minimally invasive anterior pelvic internal fixation: an anatomic study comparing Pelvic Bridge to INFIX. Injury. 2018;49(2):309–14.

    Article  PubMed  Google Scholar 

  29. Scherer J, Tiziani S, Sprengel K, Pape H-C, Osterhoff G. Subcutaneous internal anterior fixation of pelvis fractures-which configuration of the InFix is clinically optimal?-a retrospective study. Int Orthop. 2019;43(9):2161–6.

    Article  PubMed  Google Scholar 

  30. Solitro GF, Whitlock K, Amirouche F, Mehta AI, Mcdonnell A. Currently adopted criteria for pedicle screw diameter selection. Int J Spine Surg. 2019;13(2):132–45.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Stevenson AJ, Swartman B, Bucknill AT. Percutaneous internal fixation of pelvic fractures. German version. Unfallchirurg. 2016;119(10):825–34.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. AIIMS, Jodhpur, India

    Abhay Elhence & Akshat Gupta

Authors
  1. Abhay Elhence
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  2. Akshat Gupta
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Editor information

Editors and Affiliations

  1. NH Narayana Superspeciality and Multispeciality Hospitals, Howrah, West Bengal, India

    Arindam Banerjee

  2. Technical University of Munich, Munich, Germany

    Peter Biberthaler

  3. Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

    Saseendar Shanmugasundaram

Section Editor information

  1. Institute of Orthopaedic Surgery, Max Hospital, Mohali, Punjab, India

    Ramesh K Sen

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Elhence, A., Gupta, A. (2023). External Fixation in Pelvi-acetabular Implantology. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-19-7540-0_95

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  • DOI: https://doi.org/10.1007/978-981-19-7540-0_95

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-7539-4

  • Online ISBN: 978-981-19-7540-0

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