Pelvic Ring Stabilization Using Anterior Subcutaneous Internal Fixation Bladder Exstrophy Repair Surgical/Technical Tips

Abstract

BACKGROUND

Bladder exstrophy is a congenital condition involving malformation of anterior abdominal wall leading to an extruded bladder and other genitourinary and musculoskeletal system abnormalities. Orthopedically, patients with classic bladder exstrophy present with an “open” bony pelvis deformity with an obvious symphysis pubis diastasis. Multiple surgical techniques have been described for correction of the bony pelvis deformity in classic bladder exstrophy, including that described by Sponseller, et al. They described bilateral double iliac osteotomies and with anterior pelvic ring fixation using external fixator devices to maintain reduction. However, external fixators are cumbersome, unsightly and have an increased risk for pin tract infection due to its location and association to bladder defects, which may cause exposure to irritants and contaminants such as urine and feces. Furthermore, external fixators can be costly due to the complexity of the constructs to maintain the reduction. We believe subcutaneous anterior pelvic internal fixator (INFIX) is a an effective alternative for anterior pelvic ring fixation and stabilization in older bladder exstrophy patients.

METHODS

We described a 12-year-old female with bladder exstrophy who was treated using Sponseller’s technique for bony correction. However, the use of external fixation was substituted with the use of INFIX, which typically is reserved for adult pelvic trauma.

RESULTS

Preoperative imaging revealed 6.3 cm of anterior pubic symphysis diastasis. The immediate post-operative films yielded pelvis diastasis correction to 1.6 cm. Imaging post removal of implant demonstrated anterior symphysis diastasis of 2.9 cm, which represented a 1.3 cm increase since INFIX removal, but a 3.4 cm overall decrease from initial presentation.

CONCLUSION

INFIX is a novel fixation technique that is well tolerated and an effective alternative for anterior pelvic ring fixation and stabilization in older bladder exstrophy patients. In addition to the strength of the fixation, all these benefits, whether cosmetic, functional or monetary, can also add a potential psychological benefit to the patient and the caregiver.

LEVEL OF EVIDENCE

Level IV Therapeutic Studies – Investigating the Results of Treatment