Minimally invasive circumferential fixation using TIFI and INFIX for unstable pelvic ring injuries: a prospective evaluation of clinical and radiological outcomes.

PURPOSE: To evaluate the clinical and radiological outcomes of minimally invasive circumferential fixation using combined trans-iliac internal fixation (TIFI) and anterior internal fixation (INFIX) in unstable pelvic ring injuries.

METHODS: A prospective study was conducted between 2022 and 2023 including 30 patients with unilateral unstable pelvic fractures (Tile B2 and C1). Patients were followed for a minimum of 12 months (mean 22 ± 4.7 months). Functional outcomes were assessed using the Majeed Score and Pelvic Outcome Score. Radiological assessment included displacement measurements, reduction quality, maintenance of reduction, and time to union.

RESULTS: Thirty patients (mean age 32.2 ± 14.9 years) were included. Mean operative time was 103.5 ± 10.5 min, blood loss 335 ± 65.8 mL, and fluoroscopy time 52 ± 14.7 s. Pelvic displacement improved from 15.8 ± 4.6 mm preoperatively to 3.6 ± 2.4 mm postoperatively, with a mean correction of 12.2 ± 4.5 mm and minimal loss of reduction (0.3 ± 0.8 mm). At one year, mean Majeed and Pelvic Outcome scores were 89.1 ± 5.6 and 34.6 ± 2.6, respectively. Mean time to union was 13.4 ± 2.1 weeks, with 90% excellent-good reductions (Matta criteria) and 100% union. Complications included superficial infection (13.3%), lateral femoral cutaneous nerve irritation (13.3%), and asymptomatic heterotopic ossification (3.3%).

CONCLUSION: Circumferential fixation using TIFI and INFIX achieved reliable reduction, maintained alignment until union, and was associated with favorable clinical and radiological outcomes in selected unstable pelvic ring injuries. The present findings demonstrate the feasibility and satisfactory performance of this technique; however, comparative studies are required to determine its relative advantages compared with other fixation strategies.