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External fixation in early treatment of unstable pelvic fractures
San-bao Hu1, Hong Xu, Heng-bing Guo
1Department of Orthopaedics, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China. husanbao2003@yahoo.com.cn
Insights
Early external fixation for unstable pelvic fractures improves hemodynamic stability and reduces complications. This method is effective as a definitive treatment, especially for shock patients.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Skeletal Reconstruction
Background:
- Unstable pelvic fractures pose significant risks, including malunion, hemorrhage, and hemodynamic instability, particularly in facilities lacking open reduction internal fixation (ORIF) capabilities.
- Early intervention is crucial to mitigate these life-threatening complications.
Purpose of the Study:
- To investigate the efficacy of early external fixation (within 7 days) for patients with unstable pelvic fractures.
- To assess the impact of early external fixation on hemodynamic stability in shock patients.
Main Methods:
- Retrospective analysis of 32 patients with unstable pelvic fractures (Tile B: 18, C: 14) treated with early external fixation (within 7 days).
- Comparison of fluid infusion and blood transfusion volumes in 15 shock patients treated with early external fixation versus a historical cohort (1993-1998) without early fixation.
Main Results:
- All fractures healed within 12 weeks, with patients ambulating with crutches by 6-8 weeks post-fixation.
- Early external fixation significantly reduced fluid infusion and blood transfusion volumes in shock patients compared to the historical cohort.
- Seven patients experienced sequelae, including lumbosacral pain and erectile dysfunction.
Conclusions:
- Early application of external fixation in unstable pelvic fractures positively impacts hemodynamic stability.
- External fixation serves as an effective definitive treatment option for unstable pelvic fractures.
Background:
Patients with pelvic fractures are often treated in hospitals without the capacity to implement an open reduction internal fixation (ORIF). This often leads to pelvic malunion in patients with unstable pelvic fracture, shock or even death due to uncontrollable pelvic hemorrhage and unstable hemodynamics. This study explored the role of early external fixation (within 7 days) for patients with unstable pelvic fractures.
Methods:
A retrospective analysis was conducted on 32 patients with unstable pelvic fractures treated with early external fixation from January 2005 to January 2010 (Tile type B: 18 cases; C: 14 cases). The study comprised 28 males and 4 females, with a mean age of (32 ± 8) years (range, 21-56 years). Of these patients, 22 were treated with emergency pelvic external fixation and 10 were treated with external fixation within 1-7 days. Fifteen cases suffered traumatic hemorrhagic shock. A statistical analysis was conducted to compare fluid infusion and blood transfusion volumes within the first 24 hours of these shock patients with another cohort of patients treated without early external fixation from January 1993 to January 1998.
Results:
The average follow-up was (34.7 ± 14.6) months (range, 6-66 months). Six to eight weeks after external fixation, patients could walk with crutches; by 12 weeks, external fixation was removed and all fractures had healed. Seven patients presented with sequelae, including 3 patients with long-term lumbosacral pain, 3 patients with erectile dysfunction and 1 patient with Morel-Lavallee lesion and other complications. The 15 shock patients in this study (2005-2010 group) required significantly lower volumes of fluid infusion and blood transfusion (P(fluid) = 0.000; P(transfusion) = 0.000) as compared to the 1993-1998 cohort.
Conclusions:
The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability, with outstanding efficacy as a final fixation option for unstable pelvic fractures.
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