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Anterior pelvic subcutaneous internal fixator application: an anatomic study.

Caroline Moazzam1, Archie A Heddings, Patrick Moodie

  • 1Department of Orthopaedic Surgery, University of Kansas, Kansas City, KS, USA.

Journal of Orthopaedic Trauma
|February 17, 2012
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Summary

This study found that anterior pelvic internal fixators (APIF) do not significantly risk nearby nerves and blood vessels. Reproductive structures like the spermatic cord are easily avoided during APIF placement for pelvic ring disruptions.

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Area of Science:

  • Anatomy
  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Anterior pelvic internal fixator (APIF) placement for pelvic ring disruptions lacks direct visualization of critical structures.
  • Potential risks include injury to nerves (LFCN, IIN, IHN, femoral) and vessels (femoral artery/vein), as well as reproductive organs.

Purpose of the Study:

  • To identify and quantify the risk to specific anatomic structures during subcutaneous APIF application.
  • To assess the proximity of fixator screw constructs to nerves and vessels in cadaveric specimens.

Main Methods:

  • Laboratory investigation using 5 fresh, frozen cadaveric specimens.
  • Dissection to identify relationships between APIF screw constructs and key neurovascular and reproductive structures.
  • Measurement of distances from implant to identified structures using calipers.

Main Results:

  • Precontoured 3.5 locking reconstruction plates did not violate pelvic neurovascular structures.
  • Spermatic cord/round ligament were easily visualized and avoided (mean distance 0.4 cm).
  • Nerves (IHN, IIN, LFCN) and major vessels (femoral nerve, artery, vein) remained at safe distances (mean distances 1.5-2.2 cm).

Conclusions:

  • Subcutaneous APIF placement does not pose a significant risk to the LFCN, IIN, IHN, femoral nerve, artery, or vein.
  • Reproductive structures are visualized and can be safely avoided during APIF implantation.
  • APIF is a safe option for augmenting anterior pelvic ring disruption treatment.