Establishing the safety of the lateral femoral cutaneous nerve when using the Bridging Infix for anterior pelvic fixation

Authors

Keywords:

Bridging Infix, lateral femoral cutaneous nerve, anterior pelvic fixation, anterior superior iliac spine, pubic tubercle

Abstract

Objectives: Established subcutaneous internal fixation techniques have shown a better quality of life with reduced pain. However, complications still arise with the most significant being injury of the lateral femoral cutaneous nerve (LFCN). A novel minimally invasive modified technique, the Bridging Infix, has been proposed, however the safety of the LFCN during the procedure is currently unknown. Therefore, the aim of the study was to determine the relationship between the Bridging Infix and the LFCN.

Patients and methods: Fifty formalin-fixed cadaveric specimens and two fresh frozen cadaver specimens were utilized in the study. The Bridging Infix was inserted as per the technique guide. Superficial dissection of the surgical site was subsequently conducted. Bilateral measurements of the distance between the LFCN and the implant as well as palpable bony landmarks were taken to determine safe zones for implant placement.

Results: Overall the LFCN was identified coursing deep to the inguinal ligament. The minimum distance from the LFCN to the most proximal cortical screw was 18.00 mm. The mean distance from the most proximal screw to the LFCN was 37.97 ± 12.20 mm.

Conclusion: The LFCN was not injured or impinged by the Bridging Infix in any of the cadaver specimens used in this study. Thus, the surgical procedure can be considered safe if layer by layer dissection is employed and the screws are directly inserted on the iliac crest, with no pressure being applied within three finger breadths medial to the anterior superior iliac spine (ASIS).

Author Biographies

Jerolize van Schalkwyk, University of Pretoria

Department of Anatomy, University of Pretoria, Pretoria, South Africa

Natalie Keough, University of Pretoria

Department of Anatomy, University of Pretoria, Pretoria, South Africa and Department of Anatomy and Cellular Biology, Khalifa University, Abu Dhabi, United Arab Emirates and Clinical Anatomy and Imaging, Warwick Medical School, University of Warwick, Coventry, United Kingdom

Sven Strydom, University of Pretoria

Department of Orthopaedics, University of Pretoria, Kalafong Tertiary Hospital, Pretoria, South Africa

Christiaan H Snyckers, Eugene Marais Hospital

Orthopaedic Surgery, Private Practice, Eugene Marais Hospital, South Africa

Andries Masenge, University of Pretoria

Department of Statistics, University of Pretoria, Pretoria, South Africa

Nkhensani Mogale, University of Pretoria

Department of Anatomy, University of Pretoria, Pretoria, South Africa

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Published

2023-11-24

Issue

Section

Trauma