{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T13:14:12Z","timestamp":1778850852278,"version":"3.51.4"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To evaluate the clinical performance, screw placement accuracy, and complication profile of intraoperative computed tomography (CT)-guided anterior subcutaneous internal fixation (INFIX) for unstable anterior pelvic ring fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Single tertiary emergency medical center, equivalent to a Level I Trauma Center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Selection Criteria:<\/jats:title>\n                    <jats:p>A retrospective review was performed of skeletally mature patients with unstable anterior pelvic ring injuries (Orthopaedic Trauma Association\/AO type 61) treated with CT-navigated INFIX fixation between December 2020 and December 2024. Patients with incomplete imaging or follow-up were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n                    <jats:p>Primary outcomes included operative time, intraoperative blood loss, screw placement accuracy (axial angle and skin-to-head distance), and functional outcomes using a modified Majeed score (excluding work and sexual activity domains). Complications were recorded and compared by fixation construct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>A total of 41 patients were included, with a mean age of 50.7 \u00b1 24.0 years. Mean operative time was 121.0 \u00b1 61.8 minutes, and mean intraoperative blood loss was 86.8 \u00b1 113.0 mL. Temporary external fixation was used in 48.8% of cases. The normalized modified Majeed score averaged 87.5 \u00b1 12.7, and 65.9% of patients achieved \u201cexcellent\u201d outcomes. The most frequent complication was lateral femoral cutaneous nerve injury (26.8%). No screw displacement occurred in cases with additional posterior fixation. Postoperative CT demonstrated consistent screw placement (mean axial angle, 27.0 degrees; mean skin-to-head distance, 15.3 mm), and no major neurovascular complications were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>CT-guided INFIX allowed accurate screw placement with a low rate of major complications. Early functional outcomes were favorable when assessed with a modified score tailored to the study population. Combined anterior\u2013posterior constructs enhanced fixation stability. Prospective comparative studies were warranted to clarify long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003152","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T14:00:23Z","timestamp":1769522423000},"page":"e148-e155","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Safety, Efficacy, and Screw Accuracy of CT-Navigated INFIX for Unstable Pelvic Ring Fractures: A Retrospective Study"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2474-9118","authenticated-orcid":false,"given":"Akihiko","family":"Hiyama","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taku","family":"Ukai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miyu","family":"Tamaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-20260515","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.jcot.2020.06.039","article-title":"Use of INFIX for managing unstable anterior pelvic ring injuries: a systematic review","volume":"11","author":"Kumbhare","year":"2020","journal-title":"J Clin Orthop Trauma."},{"key":"R3-20260515","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s00402-020-03742-7","article-title":"Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis","volume":"142","author":"Patel","year":"2022","journal-title":"Arch Orthop Trauma Surg."},{"issue":"suppl 6","key":"R4-20260515","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1097\/BOT.0000000000001248","article-title":"Anterior subcutaneous internal pelvic Fixation\/INFIX: a systemic review","volume":"32","author":"Vaidya","year":"2018","journal-title":"J Orthop Trauma."},{"key":"R5-20260515","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13018-022-02920-0","article-title":"The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note","volume":"17","author":"Hiyama","year":"2022","journal-title":"J Orthop Surg Res."},{"key":"R6-20260515","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1111\/os.13713","article-title":"Minimally invasive 360\u00b0 fusion using a combination of INFIX and minimally invasive spinopelvic fixation by intraoperative computed tomography navigation for unstable pelvic ring fracture: a technical note","volume":"15","author":"Hiyama","year":"2023","journal-title":"Orthop Surg."},{"key":"R7-20260515","doi-asserted-by":"crossref","first-page":"111600","DOI":"10.1016\/j.injury.2024.111600","article-title":"Advancements in pelvic ring fracture surgery: assessing INFIX screw placement accuracy with CT navigation","volume":"55","author":"Hiyama","year":"2024","journal-title":"Injury"},{"key":"R8-20260515","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1051\/sicotj\/2019019","article-title":"The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic 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report of technique, indications and complications","volume":"99-b","author":"Dahill","year":"2017","journal-title":"Bone Joint J."},{"key":"R15-20260515","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s13018-016-0468-9","article-title":"A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures","volume":"11","author":"Hoskins","year":"2016","journal-title":"J Orthop Surg Res."},{"key":"R16-20260515","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":"R17-20260515","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13037-024-00421-z","article-title":"Evolution of management strategies for unstable pelvic ring injuries over the past 40 years: a systematic review","volume":"18","author":"Sawauchi","year":"2024","journal-title":"Patient Saf Surg."}],"container-title":["Journal of Orthopaedic 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