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.
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.
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
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.