Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis

Background The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages....

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Published in:Archives of orthopaedic and trauma surgery 2022-05, Vol.142 (5), p.787-803
Main Authors: Patel, Sandeep, Aggarwal, Sameer, Jindal, Karan, Kumar, Vishal, Sharma, Siddhartha
Format: Article
Language:English
Subjects:
Fracture Fixation, Internal - methods
Fractures, Bone - surgery
Humans
Injuries
Medicine
Medicine & Public Health
Meta-analysis
Orthopedics
Pelvic Bones - injuries
Pelvic Bones - surgery
Prospective Studies
Retrospective Studies
Systematic review
Trauma Surgery
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Summary:Background The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages. Questions/purposes This systematic review and meta-analysis were conducted to determine the outcomes and complications of the INFIX technique for unstable pelvic ring injuries. Methods A systematic review of literature was performed on the PubMed, EMBASE and Scopus databases. Prospective and retrospective studies in all languages, whether comparative or non-comparative, pertaining to the use of INFIX in pelvic fractures were included. Studies which did not evaluate INFIX, case reports, conference abstracts and those with less than 10 cases were excluded. Cadaveric studies, technique papers and studies that did not describe the prespecified outcome measures were also excluded. Meta-analysis consisted of two different arms: a comparative arm , to compare INFIX to symphyseal plating, and a non-comparative meta-analysis arm, to determine pooled rates of outcomes and complications. Risk of bias was determined by the Methodological Index for Non-Randomised Studies (MINORS) tool. Results A total of 22 studies were included in the systematic review, of which 7 were comparative and 15 were non-comparative. 746 patients were included for qualitative analysis and pooled analysis done for 589 patients. The average follow-up of these studies ranged from a minimum of 5.4 months to a maximum of 54 months. Comparative meta-analysis ( n  = 3 studies) of plating and INFIX showed significantly lesser blood loss (mean difference = 176.46 mL; 95% CI − 207.54 to − 145.38) and shorter operative time (mean difference = 26.43 min, 95% CI − 31.79 to − 21.07) with INFIX, but no significant difference in the overall complication rates (OR 1.59, 95% CI 0.83–3.05) and functional outcome scores (mean difference = − 2.51, 95% CI − 5.73 to 0.71). Pooled analysis showed overall good radiological (mean percentage of excellent to good reduction = 91.4%, 95% CI 0.860–0.969) and functional outcomes (mean Majeed score = 86.48, 95% CI 83.34–89.61) with INFIX. The most common complications were lateral femoral cutaneous nerve (LFCN) injury (overall rate 28%, 95% CI 15.1–41%) and heterotopic ossification (HO) (overall rate 9.4%, 95% CI 5.5–13.3%); rates of other complications were low. Significant hete
ISSN:1434-3916
0936-8051
1434-3916
DOI:10.1007/s00402-020-03742-7