Since the fracture site is the major cause of bleeding in 85% external pelvic stabilisation should be used. If the patient presents to the emergency department with an unstable pelvic fracture, stabilization with wrapping is essential to decrease or stop bleeding. This includes any break of the sacrum, hip bones, or tailbone. External fixation is a quick and easy procedure for pelvic fractures stabilization for surgeons with experience with this technique. The pelvis is a ring of bone at hip level, made up of several separate bones.
A popular term for a complex pelvic fracture, in which an anterior compression force disrupts the sacroiliac joints by more than 4 mm, causing diastasis of the symphysis pubis of more than 5 mm and externally rotates each hemipelvis. Hemodynamic stability of polytrauma patients might be compromised at any moment, especially when the risk of major blood vessel injury is high, i. Open reduction and internal fixation orif is preferred for definitive management and has been demonstrated to provide superior results. Critical management of deadly pelvic injuries jems. Decreases pelvic volume indicated in open book and unstable pelvis rarely required for lateral compression fractures simple 4 or 6 pin frame in iliac crest pins at 45 o to each other rarely definitive as has nursing issues. Common causes include falls, motor vehicle collisions, a vehicle hitting a pedestrian, or a direct crush injury. Types and classification of fractures causes of fractures. The mortality rate from open pelvic fractures was 19% 10 deaths out of 52 patients. The most common indication for external fixation is in a critically ill, unstable patient with a translationally unstable pelvic injury tile c. Internal fixation refers to plates and screws applied directly onto the fracture sites after realignment.
A pelvic fracture is a break of the bony structure of the pelvis. Pelvic ring injuries are severe injuries that require special treatment for the best. Application of multiplanar external fixator to pelvis and then external fixation of pelvic ring fracture, specifically external fixation of the sacral fracture, left acetabular fracture, pubic symphysis diastasis and pubic ramus fracture. Scrotal, labial, flank, and inguinal hematomas commonly accompany pelvic ring injuries and are indicative of intrapelvic hemorrhage. The fractures of adult pelvis are generally classified.
In younger people significant trauma is typically required while in older people less significant trauma can result in a. Screws or a clamp will be used to hold the device to your pelvic bones. The mortality rate from closed pelvic fractures was. Open book pelvic injuries result from an anteroposterior compression injury to the pelvis and result in a combination of ligamentous rupture andor fractures to both the anterior and posterior arches 5.
Learning hub for surgical training and assessment for residents. Definition a pelvic fracture is a break in one or more bones of the pelvis. An external fixation device may be put on your hips to hold the broken bones together while they heal. Open book fracture definition of open book fracture by. A piece of metal equipment called an external fixation device may be put on your hips to hold the broken bones together while they heal. Open book pelvic injury radiology reference article. For open tibial fractures in children, there is an increasing trend of using orthopedic cast rather than external fixation. Unstable pelvic fractures should be wrapped eg, in sheets or stabilized with a commercially available pelvic binder as soon as possible in the emergency department.
External pelvic fixation epf and the pelvic cclamp have been used more recently in an attempt to reduce pelvic volume and control hemorrhage associated with pelvic fracture. External fixation does not offer any advantages over pelvic binding in the initial management of pelvic fractures, although pelvic binders may impair surgical access. Exclude intraabdominal bleeding 40% of patients with pelvic fractures have an intraabdominal source of bleeding. Current trends in the surgical treatment of openbook.
Thank you for viewing this presentation on open reduction and fixation of pelvic ring fractures and injuries. Pelvic fracture inpatient care what you need to know. An openbook pelvic fracture is a term used to describe any fracture that significantly disrupts the pelvic ring. Open reduction and fixation of pelvic ring injuries 17. Compared to external fixation, unreamed intramedullary nailing has similar rates of deep infection, delayed union and nonunion following surgery. Some pelvic fractures involve breaking more than one of the bones, and these are particularly serious as the bones are more likely to slip out of line. The fixator pins are inserted just above the anteroinferior iliac spine. Pelvic external fixation consists of pins usually inserted into the iliac bones and then connected together by clamps and bars.
Metal pins, screws, or plates may be used to hold your pelvic bone together. Surgery may be needed for a severe pelvic fracture. Softtissue injuries provide an indirect measurement of the energy sustained by the patient. Outcome, unstable pelvic fracture, internal fixation, open reduction. Surgical complications and implications of external fixation of pelvic fractures. Abdelgawad introduction injuries to the pelvic ring range from simple stable fractures as the result of lowenergy forces to lifethreatening injuries with hemodynamic instability. In about 24 months 2008 to 2010, open book pelvic fractures, according to tiles classification were treated with two different techniques, na external pelvic fixator and internal fixation using. Open reduction and fixation of pelvic ring injuries youtube. Moroni a, et al, techniques to avoid pin loosening and infection in external fixation. Description the pelvis is a butterflyshaped group of bones located at the base of the spine. Pelvic fractures merck manuals professional edition. The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability, with outstanding efficacy as a.
External fixation of pelvic fractures 651 figure 2. The majority of these fractures are what is commonly referred to as an open book pelvic fracture given the opening of the pubic symphysis anteriorly. Open subtypes 2 your digital gateway to expertise, education, and innovation. Pelvic fracture definition of pelvic fracture by medical. Open pelvic fractures are rare, with an estimated incidence of 24% of all pelvic fractures. Comparison between internal and external fixation m akbar, rana muhammad arshad, muhammad hanif, raza elahi rana abstract the objective of this study was to compare two different techniques of pelvic. A 45yearold male patient with a bilateral open book pelvis fracture stabilised with external fixation. In a study of 14 hemodynamically unstable patients with pelvic fractures, sadri et al. The fractured bones can be realigned using either open or closed reduction. Open book pelvic injuries are most often the result of highenergy trauma and are associated with significant morbidity and mortality due to associated vascular injuries pathology. Followed by orthopedic consultation to determine whether external screw fixation or open reduction with internal fixation orif is needed.
An international group of 176 practicing trauma surgeons experienced in pelvic ring fracture fixation participated in an ao foundation survey asking for their preferred standard surgical fixation anterior alone or anterior plus posterior combined for otaao type 61b1. Orthopedic consultation is needed when pelvic fractures are unstable to determine whether orif or external percutaneous screw fixation should be done. Open reduction internal fixation of the sacroiliac joint. The rationale for acute external pelvic fixation consists of reducing the intrapelvic volume in open book equivalent apc23 and vertical shear injuries by decreasing the retroperitoneal bleeding space, and to provide a stable counterpressure to the packed lap sponges for effective pelvic packing.
Pelvic fractures account for 3% to 8% of all fractures seen in the emergency room but are present in up to 25%. Large arteries pass near these ligaments and can get torn resulting in massive blood loss. Pelvic fracture, external fixation, tension band wiring introduction the pelvic fractures account for 3% of all fractures1. Hip fractures require gentle handling and immobilization to prevent displacement of the fracture, aggravation of bleeding, or disruption of a pelvic hematoma. Surgical complications and implications of external. Subcutaneous haemorrhage shows the severity of pelvic bleeding. Definitive imaging ct abdomen and pelvis with iv contrast and treatment of pelvic fractures e. Complications may include internal bleeding, injury to the bladder, or vaginal trauma. Unstable pelvic fractures include disruption of the ring anteriorly at the symphysis pubis or through a pubic bone and are broadly categorized into three types.
Pelvic fractures fractures of the pelvis account for less than 5% of all skeletal injuries, but it is important because it associated with. Pelvic fracture surgery uw orthopaedics and sports. Pelvis injuries the american association for the surgery. External fixation in pelvic fractures springerlink. Open book pelvic fracture and malgaigne pelvic fracture. Open pelvic fractures are characterized by direct communication between the fracture hematoma and the external environment through the rectum, vagina, or skin. Open reduction internal fixation of the sacroiliac joint and sacrum henry claude sagi definition pelvic fractures are serious injuries associated with a diverse assortment of morbidities and mortality rates ranging from 0% to 50%. Diastasis widening of the pubic symphysis greater than 1 cm can represent instability with diastasis greater than. Unstable ipsilateral anterior and posterior fractures of the pelvic ring, with resultant superior displacement of one hemipelvis.
Stabilize fracture with pelvic binder or bed sheet wrapped around greater trochanter physicians often make mistake of wrapping around the iliac crest if suspect pelvic injury and patient is unstable, place pelvic bindersheet immediately then obtain xray when patient is stable. You may need surgery to repair the pelvic fracture and other injuries. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. External fixation is indicated as the immediate treatment in a hemodynamically unstable patient with an unstable pelvic fracture. Pelvic fractures are often caused by highenergy trauma, and these patients often have multiple injuries. Open reduction and internal fixation orif is preferred for.
Open reduction with internal fixation may be required and is performed when the patient is judged to be hemodynamically stable. In this instance, the front of the pelvis opens like a book. The outcome of surgically treated traumatic unstable. The pelvis consists of the pubis, ilium, and ischium bones among others held together by tough ligaments. The severity of the injuries is reflected in the five deaths occurring within 48 h of transfer to our unit. This injury results in tears of the strong pelvic ligaments that hold the pelvis bones together. A pelvic fracture is a break in any one of those bones. Fractures and dislocations of the pelvis involve, in broad terms, injuries to the anterior and posterior structures of the pelvic ring. Softtissue injury is observed along a continuum from superficial abrasions and lacerations, to closed internal degloving injuries, to open wounds. Pelvic fracture treated with modular pintobar external fixation.