Sasagawa Takeshi
Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama city, Toyama Prefecture, 930-8550, Japan.
J Orthop Case Rep. 2021 Jul;11(7):33-36. doi: 10.13107/jocr.2021.v11.i07.2304.
External fixation, various subcutaneous screw fixations, and plate fixation can be considered as fixation methods for unstable pelvic ring fractures. We describe a first case of treated unstable pelvic ring injury using a dual internal anterior subcutaneous fixator we called "dual INFIX," comprising four screws, two subcutaneous rods, and two cross-link connectors, without posterior fixation.
An 81-year-old man sustained an unstable pelvic injury (AO type B2) with fracture of the left ilium and pubis. Dual INFIX was used to stabilize the pelvic ring injury. Polyaxial screws were introduced along a path between the anterior inferior iliac spine and ipsilateral posterior superior iliac spine until the head of the screw lay immediately above the fascia. Bilateral cranial screws were connected by a rod passed subcutaneously, and caudal screws were connected by the other rod. Finally, cross-link connectors connected cranial and caudal rods on the right and left. One year after the first operation, the patient could walk without a cane and had no limitation of daily living and bony fusion was achieved.
The stability of the pelvic ring of dual INFIX was sufficient to achieve bony fusion in this case. The stability of dual INFIX should be stronger than that of INFIX. Dual INFIX as with INFIX has other advantages such as ease of management compared with external fixation, and nonnecessity of strict anatomical reduction compared with various percutaneous screw fixation. Furthermore, this technique is simple and minimally invasive compared with plate fixation because it does not require open surgery. However, because the type C fracture with an unacceptable position of reduction by closed reduction has the possibility to become a symptomatic malunion, such cases should not be treated by this method. Furthermore, it is necessary for pelvic stabilization using dual INFIX that the contralateral pelvis is intact because dual INFIX stabilizes the fracture side with the other side of the pelvis. Dual INFIX can be considered as an option of fixation methods for type B-1 or 2 pelvic ring injuries.
外固定、各种皮下螺钉固定和钢板固定可被视为不稳定骨盆环骨折的固定方法。我们描述了首例使用我们称为“双INFIX”的双前路皮下内固定器治疗不稳定骨盆环损伤的病例，该固定器由四颗螺钉、两根皮下杆和两个交联连接器组成，无需后路固定。
一名81岁男性遭受不稳定骨盆损伤（AO B2型），伴有左髂骨和耻骨骨折。使用双INFIX稳定骨盆环损伤。多轴螺钉沿髂前下棘和同侧后上棘之间的路径插入，直到螺钉头部位于筋膜上方。双侧颅骨螺钉通过皮下穿过的杆连接，尾侧螺钉通过另一根杆连接。最后，交联连接器连接左右两侧的颅骨和尾侧杆。首次手术后一年，患者无需拐杖即可行走，日常生活无限制，实现了骨融合。
在该病例中，双INFIX的骨盆环稳定性足以实现骨融合。双INFIX的稳定性应强于INFIX。与INFIX一样，双INFIX还有其他优点，如与外固定相比易于管理，与各种经皮螺钉固定相比无需严格解剖复位。此外，与钢板固定相比，该技术简单且微创，因为它不需要开放手术。然而，由于闭合复位后位置不可接受的C型骨折有可能成为有症状的畸形愈合，此类病例不应采用该方法治疗。此外，使用双INFIX进行骨盆稳定时，对侧骨盆必须完整，因为双INFIX通过骨盆的另一侧稳定骨折侧。双INFIX可被视为B-1或2型骨盆环损伤固定方法的一种选择。
