{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:31:24Z","timestamp":1785825084738,"version":"3.56.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec><jats:title>Objective:<\/jats:title><jats:p>To describe our experience using the anterior internal pelvic fixator (INFIX) for treating pelvic ring injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design:<\/jats:title><jats:p>Case Series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting:<\/jats:title><jats:p>Level 1 Trauma Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients:<\/jats:title><jats:p>Eighty-three patients with pelvic ring injuries were treated with INFIX. Follow-up average was 35 months (range 12\u201380.33).<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention:<\/jats:title><jats:p>Surgical treatment of pelvic ring injuries included reduction, appropriate posterior fixation, and INFIX placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome Measurements:<\/jats:title><jats:p>Reduction using the pelvic deformity index and pubic symphysis widening, Majeed functional scores, complications; infection, implant failure, heterotopic ossification (HO), nerve injury, and pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>All patients healed in an appropriate time frame (full weight bearing 12 weeks postoperation). The average pelvic deformity index reduction (injury = 0.0420 \u00b1 0.0412, latest FU = 0.0254 \u00b1 0.0243) was 39.58%. The average reduction of pubic symphysis injuries was 56.92%. The average Majeed score of patients at latest follow-up was 78.77 (range 47\u2013100). Complications were 3 infections, 1 case of implant failure, 2 cases implantation too deep, 7 cases of lateral femoral cutaneous nerve irritation, and 3 cases of pain associated with the device. HO was seen in &gt;50% of the patients, correlated with increased age (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.007), injury severity score (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.05) but only 1 case was symptomatic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>The pelvic injuries had good functional and radiological outcomes with INFIX and the appropriate posterior fixation. The downside is removal requiring a second anesthetic, there is a learning curve, HO often occurs, the lateral femoral cutaneous nerve may get irritated which often resolves once the implants are removed. Surgery-specific implants need to be developed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence:<\/jats:title><jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p><\/jats:sec>","DOI":"10.1097\/bot.0000000000000781","type":"journal-article","created":{"date-parts":[[2017,1,12]],"date-time":"2017-01-12T01:26:06Z","timestamp":1484184366000},"page":"252-259","source":"Crossref","is-referenced-by-count":49,"title":["Midterm Radiographic and Functional Outcomes of the Anterior Subcutaneous Internal Pelvic Fixator (INFIX) for Pelvic Ring Injuries"],"prefix":"10.1097","volume":"31","author":[{"given":"Rahul","family":"Vaidya","sequence":"first","affiliation":[{"name":"4G University Health Center, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University, Detroit, MI;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam Jonathan","family":"Martin","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine, Detroit, MI;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Roth","sequence":"additional","affiliation":[{"name":"Detroit Medical Center, Wayne State University, Detroit, MI; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick","family":"Tonnos","sequence":"additional","affiliation":[{"name":"Detroit Medical Center, Michigan State University, Detroit, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryant","family":"Oliphant","sequence":"additional","affiliation":[{"name":"Detroit Medical Center, Wayne State University, Detroit, MI; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Carlson","sequence":"additional","affiliation":[{"name":"Detroit Medical Center, Wayne State University, Detroit, MI; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1007\/s004020000142","article-title":"The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator","volume":"120","author":"Arazi","year":"2000","journal-title":"Arch Orthop Trauma Surg."},{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/00005131-200009000-00003","article-title":"Distraction external fixation in lateral compression pelvic fractures","volume":"14","author":"Bellabarba","year":"2000","journal-title":"J Orthop Trauma."},{"key":"R4-20230828","first-page":"296","article-title":"A simple supraacetabular external fixation for pelvic ring fractures [in German]","volume":"17","author":"Gansslen","year":"2005","journal-title":"Oper Orthop Traumatol."},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/BOT.0b013e318030e3e4","article-title":"Stabilization of unstable pelvic fractures with supraacetabular compression external fixation","volume":"21","author":"Gardner","year":"2007","journal-title":"J Orthop Trauma."},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/01.blo.0000069899.31220.d7","article-title":"Placement of half-pins for supra-acetabular external fixation: an anatomic study","author":"Haidukewych","year":"2003","journal-title":"Clin Orthop Relat Res."},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00005373-199807000-00024","article-title":"Primary external fixation of rotationally unstable pelvic fractures in obese patients","volume":"45","author":"Hupel","year":"1998","journal-title":"J Trauma."},{"key":"R8-20230828","first-page":"66","article-title":"The role of external fixation in pelvic disruptions","author":"Kellam","year":"1989","journal-title":"Clin Orthop Relat Res."},{"key":"R9-20230828","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1302\/0301-620X.91B9.22093","article-title":"Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame","volume":"91","author":"Lefaivre","year":"2009","journal-title":"J Bone Joint Surg Br."},{"key":"R10-20230828","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1302\/0301-620X.81B6.0810955","article-title":"Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients","volume":"81","author":"Lindahl","year":"1999","journal-title":"J Bone Joint Surg Br."},{"key":"R11-20230828","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.injury.2004.11.016","article-title":"Complications of temporary and definitive external fixation of pelvic ring injuries","volume":"36","author":"Mason","year":"2005","journal-title":"Injury"},{"key":"R12-20230828","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/00003086-198009000-00010","article-title":"Modern concepts of external skeletal fixation of the pelvis","author":"Mears","year":"1980","journal-title":"Clin Orthop Relat Res."},{"key":"R13-20230828","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/00005373-199311000-00003","article-title":"Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation","volume":"35","author":"Riemer","year":"1993","journal-title":"J Trauma."},{"key":"R14-20230828","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s12306-010-0084-5","article-title":"External fixation in pelvic fractures","volume":"94","author":"Scaglione","year":"2010","journal-title":"Musculoskelet Surg."},{"key":"R15-20230828","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/BOT.0b013e3181a2aec3","article-title":"The subcristal pelvic external fixator: technique, results, and rationale","volume":"23","author":"Solomon","year":"2009","journal-title":"J Orthop Trauma."},{"key":"R16-20230828","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1302\/0301-620X.81B6.0810941","article-title":"The management of unstable injuries of the pelvic ring","volume":"81","author":"Tile","year":"1999","journal-title":"J Bone Joint Surg Br."},{"key":"R17-20230828","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1097\/00005373-200012000-00002","article-title":"Simple anterior pelvic external fixation","volume":"49","author":"Tucker","year":"2000","journal-title":"J Trauma."},{"key":"R18-20230828","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/00003086-199904000-00030","article-title":"Effect of pin location on stability of pelvic external fixation","author":"Kim","year":"1999","journal-title":"Clin Orthop Relat Res."},{"key":"R19-20230828","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1302\/0301-620X.72B4.2380212","article-title":"External fixation of the injured pelvis. The functional outcome","volume":"72","author":"Majeed","year":"1990","journal-title":"J Bone Joint Surg Br."},{"key":"R20-20230828","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.2106\/00004623-198264070-00007","article-title":"Unstable fractures of the pelvis treated by external fixation","volume":"64","author":"Wild","year":"1982","journal-title":"J Bone Joint Surg Am."},{"key":"R21-20230828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/BOT.0b013e318233b8a7","article-title":"Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series","volume":"26","author":"Vaidya","year":"2012","journal-title":"J Orthop Trauma."},{"key":"R22-20230828","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1007\/s11999-011-2233-z","article-title":"Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study","volume":"470","author":"Vaidya","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"R23-20230828","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1007\/s11999-012-2287-6","article-title":"Is application of an internal anterior pelvic fixator anatomically feasible?","volume":"470","author":"Merriman","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"R24-20230828","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00113-009-1623-0","article-title":"The pelvic subcutaneous cross-over internal fixator [in German]","volume":"112","author":"Kuttner","year":"2009","journal-title":"Der Unfallchirurg."},{"key":"R25-20230828","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1007\/s00264-013-2032-0","article-title":"The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results","volume":"37","author":"Muller","year":"2013","journal-title":"Int Orthop."},{"key":"R26-20230828","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/1756-0500-7-133","article-title":"Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures","volume":"7","author":"Scheyerer","year":"2014","journal-title":"BMC Res Notes."},{"key":"R27-20230828","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1097\/BOT.0b013e31828af6a4","article-title":"Failure and salvage of \u201cINFIX\u201d instrumentation for pelvic ring disruption in a morbidly obese patient","volume":"27","author":"Owen","year":"2013","journal-title":"J Orthop Trauma."},{"key":"R28-20230828","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/BOT.0000000000000193","article-title":"Femoral nerve palsy after pelvic fracture treated with INFIX: a case series","volume":"29","author":"Hesse","year":"2014","journal-title":"J Orthop Trauma."},{"key":"R29-20230828","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1749-799X-7-31","article-title":"Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures","volume":"7","author":"Vigdorchik","year":"2012","journal-title":"J Orthop Surg Res."},{"key":"R30-20230828","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1007\/s00264-013-1890-9","article-title":"Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone","volume":"37","author":"Vigdorchik","year":"2013","journal-title":"Int Orthop."},{"key":"R31-20230828","doi-asserted-by":"crossref","first-page":"683120","DOI":"10.1155\/2013\/683120","article-title":"Monoaxial pedicle screws are superior to polyaxial pedicle screws and the two pin external fixator for subcutaneous anterior pelvic fixation in a biomechanical analysis","volume":"2013","author":"Vaidya","year":"2013","journal-title":"Adv Orthop."},{"key":"R32-20230828","first-page":"28","article-title":"Pelvic polyfractures in children. Radiographic diagnosis and treatment","author":"Keshishyan","year":"1995","journal-title":"Clin Orthop Relat Res."},{"key":"R33-20230828","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/BOT.0b013e3182945fe9","article-title":"What outcomes are important for patients after pelvic trauma? Subjective responses and psychometric analysis of three published pelvic-specific outcome instruments","volume":"28","author":"Lefaivre","year":"2014","journal-title":"J Orthop Trauma."},{"key":"R34-20230828","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/BOT.0b013e31829efcc5","article-title":"Radiographic displacement in pelvic ring disruption: reliability of 3 previously described measurement techniques","volume":"28","author":"Lefaivre","year":"2014","journal-title":"J Orthop Trauma."},{"key":"R35-20230828","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1302\/0301-620X.71B2.2925751","article-title":"Grading the outcome of pelvic fractures","volume":"71","author":"Majeed","year":"1989","journal-title":"J Bone Joint Surg Br."},{"key":"R36-20230828","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s00264-013-1891-8","article-title":"Sequential reduction and fixation for windswept pelvic ring injuries corrects the deformity until healed","volume":"37","author":"Vaidya","year":"2013","journal-title":"Int Orthop."},{"issue":"suppl 2","key":"R38-20230828","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1097\/BOT.0000000000000583","article-title":"The anterior subcutaneous pelvic fixator (INFIX) in an anterior posterior compression type 3 pelvic fracture","volume":"30","author":"Vaidya","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"10 suppl","key":"R39-20230828","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium\u20142007: Orthopaedic Trauma Association classification, database and outcomes committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma."},{"key":"R40-20230828","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/00005373-198907000-00012","article-title":"Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome","volume":"29","author":"Dalal","year":"1989","journal-title":"J Trauma."},{"key":"R41-20230828","doi-asserted-by":"crossref","first-page":"836","DOI":"10.4236\/ojog.2014.414117","article-title":"Vaginal delivery after pelvic fracture fixation with a subcutaneous anterior fixator with review of literature of delivery mode in pelvic injuries","volume":"4","author":"Sethi","year":"2014","journal-title":"Open J Obstet Gynecol."},{"key":"R42-20230828","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/BOT.0b013e3182323aa2","article-title":"Methodology and interpretation of radiographic outcomes in surgically treated pelvic fractures: a systematic review","volume":"26","author":"Lefaivre","year":"2012","journal-title":"J Orthop Trauma."},{"key":"R43-20230828","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.injury.2015.01.040","article-title":"Internal anterior fixators for pelvic ring injuries: do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws?","volume":"46","author":"Eagan","year":"2015","journal-title":"Injury"},{"key":"R44-20230828","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1002\/ca.22149","article-title":"The bikini area and bikini line as a location for anterior subcutaneous pelvic fixation: an anatomic and clinical investigation","volume":"26","author":"Vaidya","year":"2013","journal-title":"Clin Anat."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00005131-201705000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T09:59:41Z","timestamp":1749895181000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00005131-201705000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":42,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000000781","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2017,5]]}}}