[Severe pelvic injuries: indications and techniques of skeletal fixation]

The aim of this work is to assess the role of immediate Hoffmann's external fixation frame and delayed posterior internal fixation in the management of severe pelvic injuries. We have also analysed the role of selective arteriography and embolization for controlling pelvic fractures hemorrhage and the relationship between embolization and external fixation in the management of severe bleeding. We reviewed 112 patients with severe pelvic injuries admitted to our hospital from 1986 to 1998 (71 males, 41 females). The average age was 39.8 years, mean ISS 31.2. Unstable pelvic ring fracture was present in 59 (52.6%) patients at admission in the emergency room: hemorrhagic shock in 43 patients (38.3%). Fourteen (12.5%) patients died. Eight deaths (57%) were directly caused by hemorrhagic shock, two secondary to major caval lesion, three brain lesions and two respiratory failure. The last patient died secondary to MOF. Twenty-three patients (20.5%) with unstable fracture underwent pelvic fracture ring fixation surgery: eleven (9.8%) Hoffmann's anterior external fixation frame (hemorrhage control in all patients) and eight (7.1%) delayed internal posterior fixation. Six (5.3%) patients underwent arteriography and embolization: hemorrhage was stopped in all cases and no patient died in this group.