Comparison study of minimally invasive percutaneous bridge internal fixator and traditional external fixator in treatment of unstable pelvic fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WU Gang , TAN Lun , LI Bangqing , ZHANG Caidong , ZHANG Zhiwei

Department of Orthopaedics, The 4th People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;

Corresponding?author：

WU Gang, Email: wgms2005@163.com

Keywords：

Unstable pelvic fracture; minimally invasive; percutaneous bridge internal fixator; external fixator

DOI：

10.7507/1002-1892.201907054

Video：

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Objective To evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator.Methods The clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups. In the observation group (25 cases), minimally invasive percutaneous bridge internal fixators were used, and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies. In the control group (20 cases), external fixators were used. There was no significant difference between the two groups in gender, age, cause of injury, fracture type (according to Tile classification), and time from injury to operation (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between the two groups. The reduction quality was evaluated according to the Matta standard, and functional recovery was evaluated according to the Majeed scoring standard.Results All patients were followed up 12-20 months (mean, 15 months). The operation time of the observation group was significantly longer than that of the control group (t=2.719, P=0.009); no significant difference in intraoperative blood loss was found between the two groups (t=0.784, P=0.437). There was no significant difference between the two groups in fracture healing time (t=0.967, P=0.341). According to the Matta standard, the excellent and good rate of the observation group was 92%, and that of the control group was 70%, showing no significant difference between the two groups (χ²=3.748, P=0.053). At last follow-up, according to the Majeed scoring standard, the excellent and good rate of the observation group was 88%, and that of the control group was 60%, showing significant difference between the two groups (χ²=4.717, P=0.030). The incidences of incision and nailway infection, secondary displacement of fracture, and malunion in the observation group were significantly lower than those in the control group (P<0.05); the differences in incidences of iatrogenic injury of lateral femoral cutaneous nerve, deep vein thrombosis, and loosening of fixation between the two groups were not significant (P>0.05).Conclusion Minimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures. It has the advantages of minimal trauma, stable fixation, less interference to patients’ daily life, early functional exercise, and quickly recovery after operation.

Citation： WU Gang, TAN Lun, LI Bangqing, ZHANG Caidong, ZHANG Zhiwei. Comparison study of minimally invasive percutaneous bridge internal fixator and traditional external fixator in treatment of unstable pelvic fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 563-568. doi: 10.7507/1002-1892.201907054 Copy

1.	McCormack R, Strauss EJ, Alwattar BJ, et al. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis, 2010, 68(4): 281-291.
2.	Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury, 2005, 36(5): 599-604.
3.	Palmer S, Fairbank AC, Bircher M. Surgical complications and implications of external fixation of pelvic fractures. Injury, 1997, 28(9-10): 649-653.
4.	Cole PA, Gauger EM, Anavian J, et al. Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures. J Orthop Trauma, 2012, 26(5): 269-277.
5.	Hupel TM, McKee MD, Waddell JP, et al. Primary external fixation of rotationally unstable pelvic fractures in obese patients. J Trauma, 1998, 45(1): 111-115.
6.	項舟, 段鑫, 王洪. 骨盆骨折三軸移位方式及復位原則. 中國修復重建外科雜志, 2017, 31(10): 1153-1160.
7.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
8.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
9.	黃仲, 孟維錕, 李亮, 等. 閉口萬向螺釘骶髂固定系統聯合后路部分脊柱內固定系統治療不穩定型骶骨骨折. 中國修復重建外科雜志, 2017, 31(3): 313-318.
10.	Vigdorchik JM, Esquivel AO, Jin X, et al. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res, 2012, 7: 31.
11.	李尚政, 蘇偉, 趙勁民, 等. 釘-棒系統與外固定支架固定骨盆不穩定損傷模型的生物力學比較. 中華創傷骨科雜志, 2013, 15(6): 517-520.
12.	Kuttner M, Klaiber A, Lorenz T, et al. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg, 2009, 112(7): 661-669.
13.	Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma, 2012, 26(1): 1-8.
14.	韓巍, 吳新寶, 姜鈺, 等. 內置固定架治療骨盆骨折致股神經麻痹三例. 中國修復重建外科雜志, 2016, 30(4): 523-524.
15.	Fang C, Alabdulrahman H, Pape HC. Complications after percutaneous internal fixator for anterior pelvic ring injuries. Int Orthop, 2017, 41(9): 1785-1790.
16.	Hesse D, Kandmir U, Solberg B, et al. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma, 2015, 29(3): 138-143.
17.	Reichel LM, MacCormick LM, Dugarte AJ, et al. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX. Injury, 2018, 49(2): 309-314.

1. McCormack R, Strauss EJ, Alwattar BJ, et al. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis, 2010, 68(4): 281-291.
2. Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury, 2005, 36(5): 599-604.
3. Palmer S, Fairbank AC, Bircher M. Surgical complications and implications of external fixation of pelvic fractures. Injury, 1997, 28(9-10): 649-653.
4. Cole PA, Gauger EM, Anavian J, et al. Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures. J Orthop Trauma, 2012, 26(5): 269-277.
5. Hupel TM, McKee MD, Waddell JP, et al. Primary external fixation of rotationally unstable pelvic fractures in obese patients. J Trauma, 1998, 45(1): 111-115.
6. 項舟, 段鑫, 王洪. 骨盆骨折三軸移位方式及復位原則. 中國修復重建外科雜志, 2017, 31(10): 1153-1160.
7. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
8. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
9. 黃仲, 孟維錕, 李亮, 等. 閉口萬向螺釘骶髂固定系統聯合后路部分脊柱內固定系統治療不穩定型骶骨骨折. 中國修復重建外科雜志, 2017, 31(3): 313-318.
10. Vigdorchik JM, Esquivel AO, Jin X, et al. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res, 2012, 7: 31.
11. 李尚政, 蘇偉, 趙勁民, 等. 釘-棒系統與外固定支架固定骨盆不穩定損傷模型的生物力學比較. 中華創傷骨科雜志, 2013, 15(6): 517-520.
12. Kuttner M, Klaiber A, Lorenz T, et al. The pelvic subcutaneous cross-over internal fixator. Unfallchirurg, 2009, 112(7): 661-669.
13. Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma, 2012, 26(1): 1-8.
14. 韓巍, 吳新寶, 姜鈺, 等. 內置固定架治療骨盆骨折致股神經麻痹三例. 中國修復重建外科雜志, 2016, 30(4): 523-524.
15. Fang C, Alabdulrahman H, Pape HC. Complications after percutaneous internal fixator for anterior pelvic ring injuries. Int Orthop, 2017, 41(9): 1785-1790.
16. Hesse D, Kandmir U, Solberg B, et al. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma, 2015, 29(3): 138-143.
17. Reichel LM, MacCormick LM, Dugarte AJ, et al. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX. Injury, 2018, 49(2): 309-314.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison study of minimally invasive percutaneous bridge internal fixator and traditional external fixator in treatment of unstable pelvic fractures

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