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Emergency pelvic stabilization in patients with pelvic posttraumatic instability
Dan V Poenaru1, Mircea Popescu, Bogdan Anglitoiu
12nd Orthopaedic and Traumatology Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania, danvpoenaru@gmail.com.
Insights
External fixation effectively stabilizes unstable pelvic ring disruptions, improving patient mobility and outcomes. This method is crucial in resuscitation, offering stability and reduced bleeding in acute trauma cases.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Pelvic Reconstruction
Background:
- Unstable pelvic ring disruptions are associated with significant morbidity.
- Accurate reduction and fixation are key to reducing pain and improving functional outcomes.
- Early patient mobility is facilitated by effective pelvic stabilization.
Purpose of the Study:
- To evaluate the efficacy of external fixation in stabilizing unstable pelvic ring disruptions.
- To assess functional outcomes and complication rates associated with external fixator use.
- To determine the role of external fixation in acute trauma resuscitation protocols.
Main Methods:
- Retrospective study of 30 polytrauma patients with unstable pelvic lesions.
- External fixator used for temporary or definitive stabilization.
- Data included patient demographics, trauma type, pelvic lesion classification (Tile B/C), associated injuries (ISS), fixation methods, and functional outcomes (Majeed score).
Main Results:
- Excellent Majeed functional scores achieved in 78% of patients.
- Malunions occurred in 4 patients treated solely with external fixation for Tile C lesions.
- Superficial pin track infections occurred in 3 patients; 23% mortality in patients with ISS > 50.
Conclusions:
- External fixation effectively stabilizes anterior pelvic ring lesions and can be combined with posterior stabilization.
- External fixators are valuable in acute trauma resuscitation, aiding reduction, stability, and blood loss reduction.
- External fixation can serve as a definitive stabilization method when satisfactory reduction is achieved.
Introduction:
Unstable pelvic ring disruptions have been associated with high rates of morbidity. Accurate reduction with fixation diminishes pain, permits early patient mobility, and allows the pelvic ring to improve functional outcome.
Material And Methods:
This was a retrospective study, whereby 30 polytrauma hospitalized patients were included, with unstable pelvic lesions stabilized with an external fixator as a mean of temporary or definitive fixation. Data collected for these sample were: age, sex, cause of trauma, type of pelvic lesion, associated lesions (ISS score), pelvic stabilization methods, and functional outcome. There were 17 male subjects (57%) and 13 female subjects (43%), with a mean age of 42.5 years (range 18-62 years). According to Tile classification, the unstable pelvic ring lesions prevailed; 60 % of patients were type C while three patients with type C instability had associated acetabular fractures, and 40% had type B rotational instability. Stabilization was achieved using an external fixator in 16 patients; in 14 patients the anterior ring fixation was used with an external fixator combined with posterior stabilization using percutaneous sacroiliac screws. The pelvic stabilization using the external fixator was later replaced with plates and screws (ORIF) in four patients. Follow-up at one, three, six and 12 months postoperatively was based on the Majeed functional score and radiographic assessment.
Results:
Eighteen patients (78%) had an excellent Majeed functional score, four patients had a good score, and only one patient had a fair functional outcome. Malunions were recorded in four patients with Tile C that were stabilized only by external fixation, and superficial pin track infection occurred in three patients. Within the studied group seven deaths have been recorded (23%) in patients with extremely severe associated injuries (ISS over 50), this being the decisive factor that determined the unfavourable evolution in six patients.
Conclusions:
The external fixation stabilizes the anterior pelvic ring lesions and it can be combined with the posterior stabilization using percutaneous sacro-iliac screws in case of associated lesions of the posterior ring. The external fixator is very useful especially in the acute phase, acquiring an acceptable reduction and an adequate stability in the partially unstable lesions (Tile B) and also reduces the pelvic volume and bleeding, being considered essential within the resuscitation protocols. The external fixator can be used as a permanent stabilization method when it guarantees a satisfying reduction.
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