Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2023; 14(7): 562-571
Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.562
Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study
Mohamed Abo-Elsoud, Mostafa I Awad, Mahmoud Abdel Karim, Sherif Khaled, Mohamed Abdelmoneim
Mohamed Abo-Elsoud, Mahmoud Abdel Karim, Sherif Khaled, Mohamed Abdelmoneim, Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
Mostafa I Awad, Department of Trauma and Orthopedics, Mataria Teaching Hospital, Cairo 4540046, Egypt
Author contributions: All authors have contributed to design of the study, surgical intervention, patients assessment and follow up, manuscript writing and editing.
Institutional review board statement: The study was approved by the ethical committee of faculty of medicine, Cairo university on 8/12/2018 with the number “N-147-2023”.
Clinical trial registration statement: This is not an RCT it wasn’t registered on clinical trial .gov.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors confirm that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mahmoud Abdel Karim, MD, PhD, Professor, Department of Orthopedics and Traumatology, Cairo University Hospitals, Kasr Al-Ainy Street, Cairo 11562, Egypt. mabdelkarim@hotmail.com
Received: December 28, 2022
Peer-review started: December 28, 2022
First decision: April 13, 2023
Revised: April 14, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: July 18, 2023
Processing time: 201 Days and 13.7 Hours
ARTICLE HIGHLIGHTS
Research background

Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injures is considered to be a great step to efficiently reduce the mortality rate associated with these types of injures. There is a debate on the use of either anterior subcutaneous pelvis internal fixator (INFIX) or anterior supra-acetabular external fixator (EXFIX) in the management of anterior unstable pelvic ring fracture.

Research motivation

This is one of the very few studies comparing the INFIX vs EXFIX in management of unstable anterior pelvic ring injuries.

Research objectives

The objective of this study was to compare the functional, radiological outcomes as well as complications of INFIX vs EXFIX in management of unstable pelvic ring injuries.

Research methods

A prospective cohort study was carried including 54 patients with unstable pelvic ring fractures. The patients were divided into two groups: INFIX group in which 30 cases were fixed by INFIX and EXFIX group in which the 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years) while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. Evaluation of the radiological outcomes was done using Matta and Tornetta score and functional outcomes using Majeed score.

Research results

Fifty nine patients were recruited for the study; five were lost during follow-up. Fifty-four patients were left; 30 for the INFIX and 24 for the EXFIX groups. Operative time was shorter among the EXFIX group compared to the INFIX group (P < 0.001). INFIX group had significantly better quality of fracture reduction scores (P = 0.022). All fractures united by an average of 13 wk (range; 10-16 wk) (P = 0.536). Implants were removed in both groups starting at 3 mo postoperatively. Lateral femoral cutaneous nerve injury and infection were the most common complications reported. Infection was significantly higher among the EXFIX group (P = 0.007). Eight (33.4%) patients experienced pin-track infections that were classified according to Meléndez and Colón system. One patient had a severe surgical site infection (grade V) causing loosening of the pins and fixation failure after 2 wk. As regards the INFIX group, there was a single case (3.3%) of superficial infection that was treated by intravenous antibiotics and wound dressing. INFIX group was found to have significantly better Majeed scores in all modules. The total Majeed score had an average of 92.3 and 91 for the INFIX and the EXFIX groups, respectively.

Research conclusions

This study suggests that anterior subcutaneous pelvis INFIX is associated with better radiological outcome and less rate of infection than anterior supra-acetabular EXFIX in management of patients with anterior unstable pelvic ring fractures. Benefits of INFIX use include easiness to sit, stand and walk with the implant and low incidence of surgical site infection. On the other hand, operative time of EXFIX is shorter which makes it more suitable for emergency situations.

Research perspectives

Further research studies that would have more sample size, and randomization of the patients (if feasible) are required.