Acute Pelvic Fractures: II. Principles of Management

Pelvic fractures and high energy traumas

Pelvic fractures are associated with a high mortality and morbidity and their presence should be considered in all high energy traumas. Early management is directed towards basic advanced trauma life support (ATLS) principles but it is essential to be aware of the diagnosis and management of these complex injuries.

Initial management of pelvic and femoral fractures in the multiply injured patient

The management of polytrauma patients is clinically challenging and requires a multi-disciplinary team approach. The immediate and definitive operative care of fractures represents the optimal treatment for polytrauma patients with orthopedic injuries. Early orthopedic intervention in long bone fractures and pelvic ring injuries has been shown to decrease pulmonary complications, improve hemodynamic stability, reduce ventilator time, and facilitate early patient mobilization. These factors decrease mortality and improve outcomes for patients with multiple injuries.

Diastasis of the pubic symphysis peculiar to horse riders: modern aspects of pelvic pommel injuries

Diastasis of the pubic symphysis is a well documented injury typically associated with high energy trauma. Three cases in horse riders are here described, emphasising the appropriate modern investigation, including computed tomography, and orthopaedic and urological management.

Distraction external fixation in lateral compression pelvic fractures

OBJECTIVE

To observe the results and describe the technique of closed reduction and placement of a two-pin supra-acetabular external fixator, followed by immediate weight bearing, in the treatment of displaced vertically stable lateral compression pelvic fractures.

DESIGN

Prospective, consecutive

SETTING

Regional trauma center

PATIENTS

A consecutive series of fourteen patients with displaced, vertically stable lateral compression pelvic fractures who were transported to a regional trauma center.

INTERVENTION

Surgical treatment with closed reduction and maintenance of the distraction force with a two-pin, single-bar, supra-acetabular external fixator, followed by immediate weight bearing.

MAIN OUTCOME MEASUREMENTS

Healing rate and time, operative blood loss and time, quality of reduction, time to full weight-bearing, and incidence of complications, including neurovascular deficits, loss of reduction, nonunion, pin tract infections, and chronic pain.

RESULTS

A symmetric reduction of both hemipelves was achieved in all fourteen patients. Time to healing averaged 8.2 weeks (seven to twelve weeks), and no fixator required removal before healing. There were no delayed unions or nonunions, and none of the fractures displaced significantly after initial reduction. Average surgical time was thirty-seven minutes (range, twenty-five to sixty minutes) with an estimated blood loss of less than fifty milliliters. Patients were allowed to bear full weight immediately and were able to do so without ambulatory assistive devices within an average of twelve days (range, three to eighteen days). Complications consisted of three minor pin tract infections, one temporary lateral femoral cutaneous nerve palsy, one late pin tract abscess, and one patient with chronic low-back pain.

CONCLUSIONS

Treatment of type B lateral compression injuries of the pelvic ring with anterior distraction external fixation is a highly effective yet relatively simple and minimally invasive treatment method. Surgical time and blood loss are minimal, and patients can be effectively and rapidly mobilized. Based on our experience, we believe this method to be a valuable tool in the treatment of these fractures.

Intrapelvic dislocation of the left hemipelvis as a complication of the pelvic "C" clamp: a case report and review

High-energy pelvic trauma, with posterior pelvic disruption, produces high morbidity and mortality rates. Part of the initial resuscitation has included an anterior external fixator to close the pelvic ring, thereby decreasing blood loss and reducing mortality. However, this technique has been found to be less efficacious in certain situations. This has stimulated an interest in alternative methods of stabilization, which has led to the recent development of the emergency pelvic "C" clamp. We present one of the potential pitfalls of this new device, discuss pertinent clinical and biomechanical studies, and offer suggestions regarding its use.