Anterior Subcutaneous Internal Fixation of the Pelvis: Placement of the INFIX

The treatment of displaced or unstable pelvic fractures involves surgical stabilization. Traditional methods of fixation for the anterior pelvic ring include plate fixation, screw fixation, or external fixation. Recently, a technique for using spinal pedicle screws to create an anterior subcutaneous internal fixator, also termed an “INFIX,” has been reported with some success. Although no technique has proved clinically superior, the subcutaneous technique offers significant advantages over traditional pelvic external fixation. These advantages include obviating the risk of pin tract irritation or infection, decreasing postoperative pain, and increasing the biomechanical stability of the fixation construct. Here, we review the anatomical considerations, imaging, and surgical technique for placing an anterior subcutaneous internal fixator. In addition, the surgical outcomes and complications of this specialized technique are discussed. Surgical management of pelvic ring injuries is complex, and this technique is a valuable tool in the armamentarium of pelvic surgeons.