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Starr frame-assisted and minimally invasive internal fixation for pelvic fractures: Simultaneous anterior and posterior ring stability

  • Author Footnotes
    1 Lei Xu and Kai Xie contributed equally to this work.
    Lei Xu
    Footnotes
    1 Lei Xu and Kai Xie contributed equally to this work.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
    Search for articles by this author
  • Author Footnotes
    1 Lei Xu and Kai Xie contributed equally to this work.
    Kai Xie
    Footnotes
    1 Lei Xu and Kai Xie contributed equally to this work.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
    Search for articles by this author
  • Wanbo Zhu
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
    Search for articles by this author
  • Jiazhao Yang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
    Search for articles by this author
  • Wei Xu
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
    Search for articles by this author
  • Shiyuan Fang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
    Search for articles by this author
  • Author Footnotes
    1 Lei Xu and Kai Xie contributed equally to this work.
Published:February 09, 2022DOI:https://doi.org/10.1016/j.injury.2022.02.025

      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

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      References

        • Khanna P.
        • Phan H.
        • Hardy A.H.
        • Nolan T.
        • Dong P
        Multidisciplinary management of blunt pelvic trauma.
        Semin Intervent Radiol. 2012; 29: 187-191
        • Chu C.H.
        • Tennakoon L.
        • Maggio P.M.
        • Weiser T.G.
        • Spain D.A.
        • Staudenmayer K.L.
        Trends in the management of pelvic fractures, 2008-2010.
        J Surg Res. 2016; 202: 335-340
        • Liu H.S.
        • Duan S.J.
        • Xin F.Z.
        • Zhang Z.
        • Wang X.G.
        • Liu S.D.
        Robot-assisted minimally-invasive internal fixation of pelvic ring injuries: a single-center experience.
        Orthop Surg. 2019; 11: 42-51
        • Joel M.
        • Matta J.G.Y
        Table-skeletal fixation as an adjunct to pelvic ring reduction.
        J Orthop Trauma. 2007; 21
        • Wong J.M.
        • Bewsher S.
        • Yew J.
        • Bucknill A.
        • de Steiger R.
        Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation.
        Injury. 2015; 46: 1064-1068
        • Lefaivre K.A .SA.
        • Barker B.P.
        • Overturf S.
        • Reinert C.M
        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
        • Peng Y.
        • Zhang W.
        • Zhang G.
        • Wang X.
        • Zhang S.
        • Ma X.
        • et al.
        Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury.
        J Orthop Surg Res. 2019; 14: 29
        • Chen H.
        • Jiang B.
        • Zhang Q.
        • Chang Z.
        • Yang Z.
        • Zhang J.
        • et al.
        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
        • Zhao J.X.
        • Zhang L.C.
        • Su X.Y.
        • Zhao Z.
        • Zhao Y.P.
        • Sun G.F.
        • et al.
        Early experience with reduction of unstable pelvic fracture using a computer-aided reduction frame.
        Biomed Res Int. 2018; 20187297635
        • Vaidya R.
        • Martin A.J.
        • Roth M.
        • Tonnos F.
        • Oliphant B.
        • Carlson J.
        Midterm radiographic and functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) for pelvic ring injuries.
        J Orthop Trauma. 2017; 31: 252-259
        • Merriman D.J.
        • Ricci W.M.
        • McAndrew C.M.
        • Gardner M.J.
        Is application of an internal anterior pelvic fixator anatomically feasible?.
        Clin Orthop Relat Res. 2012; 470: 2111-2115
        • Vaidya R.
        • Colen R.
        • Vigdorchik J.
        • Tonnos F.
        • Sethi A.
        Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series.
        J Orthop Trauma. 2012; 26: 1-8
        • Wu X.T.
        • Liu Z.Q.
        • Fu W.Q.
        • Zhao S.
        Minimally invasive treatment of unstable pelvic ring injuries with modified pedicle screw-rod fixator.
        J Int Med Res. 2018; 46: 368-380