Pelvic fractures are often caused by high-energy trauma. The condition of patients is complex and requires active therapy. The treatment of pelvic fractures includes conservative and surgical treatment. Surgical treatment is suitable for patients with unstable pelvic fractures. In recent years,the anterior subcutaneous internal fixator (INFIX) for the treatment of unstable pelvic fractures has been popularized and achieved extraordinary outcomes. INFIX is a relatively novel technology for the treatment of anterior pelvic ring fractures. It has excellent biomechanical properties, a wide range of indications, and has the advantages of minimally invasive, convenient care, fewer complications, and better clinical outcomes. If patients with anterior pelvic ring fractures have the indications for INFIX after careful evaluation, INFIX is recommended. This article summarizes the research progress of INFIX in the treatment of anterior pelvic ring fractures, and summarizes its surgical methods, biomechanical properties, indications, advantages, complications and clinical outcomes.
ObjectiveTo compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures.MethodsThe clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation.ResultsThe patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group (t=?11.965, P=0.000; t=?20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups (P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group (P>0.05), but there were significant differences in sitting and sexual intercourse scores (t=?4.250, P=0.003; t=?6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group (P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group (P<0.05).ConclusionCompared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.
Objective To investigate effectiveness of the modified anterior subcutaneous internal fixation (M-INFIX) in treating pubic symphysis diastasis by comparing with open reduction and plate fixation. Methods A retrospective analysis was conducted on the clinical data of 33 patients with AO/Orthopaedic Trauma Association (OTA) type C1 pelvic fractures, who were admitted between January 2020 and January 2025 and met the selection criteria. Among them, 17 patients underwent open reduction and plate fixation of the pubic symphysis (control group), and 16 patients underwent M-INFIX (modified group). There was no significant difference in baseline data, such as age, gender, and time from injury to operation, between the two groups (P>0.05). The operation time, intraoperative blood loss, and incision length of pubic symphysis were recorded and compared between groups. The quality of pelvic fracture reduction was evaluated using the Matta scoring criteria based on postoperative X-ray films, and fracture healing was observed. During follow-up, pelvic functional recovery was evaluated using the Majeed scoring criteria. Results Compared with the control group, the modified group showed shorter operation time and incision, and less intraoperative bleeding, with all differences being significant (P<0.05). All patients were followed up, with follow-up durations of (16.81±3.45) months in modified group and (19.00±3.06) months in control group, showing no significant difference (t=1.929, P=0.063). Radiographic review revealed no significant difference in the quality of pelvic fracture reduction between groups (P>0.05). Fractures healed in both groups. All posterior pedicle screws were removed in both groups. The anterior subcutaneous internal fixators were removed at 6 months after operation in 7 cases of modified group. At last follow-up, there was no significant difference in pelvic function assessed by Majeed scores and ratings between groups (P>0.05). No complication occurred in modified group, while 2 cases of screw loosening and 2 cases of incision infection occurred in control group. The difference in incidence of complications between groups was significant (P<0.05). ConclusionCompared with open reduction and plate fixation, the M-INFIX for treatment of pubic symphysis diastasis offers the advantages of fewer complications, a smaller incision, less bleeding, and shorter operation time, making it a safe and effective surgical approach.