Highlights
- •Starr frame-assisted minimally invasive internal fixation stabilizes the anterior and posterior pelvic rings simultaneously.
- •Reduced waiting time from injury to surgery and intraoperative blood loss were observed in the perioperative period.
- •Postoperative weight-bearing and improved functional outcomes were observed.
Abstract
Objective
We aimed to investigate the surgical techniques, efficacy, and safety of Starr frame-assisted
and minimally invasive internal fixation for simultaneous anterior and posterior ring
stability in pelvic fractures.
Methods
The clinical data of 22 patients with anterior and posterior pelvic ring injuries
who underwent Starr frame-assisted and minimally invasive internal fixation were retrospectively
collected. The anterior pelvic ring was fixed with an anterior subcutaneous internal
fixator (INFIX), and the posterior pelvic ring was fixed with sacroiliac screws. The
operative time, intraoperative blood loss, fluoroscopy times, number of assistants,
complications, and weight-bearing time were analyzed. The Matta score was used to
evaluate the fracture reduction. The Majeed score was used to evaluate clinical efficacy,
and Gibbon's classification was used to estimate the occurrence of sacral nerve injury.
Results
All 22 patients were treated with sacroiliac screws for posterior ring injuries, including
12 cases with single sacroiliac screws, nine with two sacroiliac screws, and one with
three sacroiliac screws. INFIX was used for all anterior ring fixation, including
two screws in seven cases, three screws in 13 cases, and four screws in two cases.
The fracture reduction quality was excellent in 15 cases, good in four cases, and
moderate in three cases by Matta scores. All patients were followed up for 6–20 (12.5 ± 5.7)
months. Callus-formation time based on postoperative X-ray was 3–8 (4.3 ± 1.2) weeks.
Weight-bearing time was 3–12 (6.3 ± 2.8) weeks after surgery. At the last follow-up,
15 patients were evaluated as excellent, five as good, and two as fair according to
the Majeed score. Gibbons’ classification showed that one of the three patients with
sacral nerve injury recovered completely and two did not recover. Complications occurred
in six patients, including one with internal fixation loosening, two with anterolateral
thigh paresthesia, one with malunion, one with nonunion, and one with heterotopic
ossification.
Conclusions
Starr frame-assisted and minimally invasive internal fixation could stabilize the
anterior and posterior pelvic rings simultaneously, overcoming the difficulty of fracture
reduction. This technique can help patients with early postoperative weight-bearing
and improved functional outcomes, providing a novel modality for the minimally invasive
treatment of pelvic ring injuries.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Multidisciplinary management of blunt pelvic trauma.Semin Intervent Radiol. 2012; 29: 187-191
- Trends in the management of pelvic fractures, 2008-2010.J Surg Res. 2016; 202: 335-340
- Robot-assisted minimally-invasive internal fixation of pelvic ring injuries: a single-center experience.Orthop Surg. 2019; 11: 42-51
- Table-skeletal fixation as an adjunct to pelvic ring reduction.J Orthop Trauma. 2007; 21
- Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation.Injury. 2015; 46: 1064-1068
- Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame.J Bone Joint Surg Br. 2009; 91: 1201-1207
- Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury.J Orthop Surg Res. 2019; 14: 29
- Intelligent monitoring system assisted pelvic fracture closed reduction for treating one case with complex pelvic fracture.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020; 34: 874-877
- Early experience with reduction of unstable pelvic fracture using a computer-aided reduction frame.Biomed Res Int. 2018; 20187297635
- Midterm radiographic and functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) for pelvic ring injuries.J Orthop Trauma. 2017; 31: 252-259
- Is application of an internal anterior pelvic fixator anatomically feasible?.Clin Orthop Relat Res. 2012; 470: 2111-2115
- Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series.J Orthop Trauma. 2012; 26: 1-8
- Minimally invasive treatment of unstable pelvic ring injuries with modified pedicle screw-rod fixator.J Int Med Res. 2018; 46: 368-380
Article info
Publication history
Published online: February 09, 2022
Accepted:
February 6,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
