Today's Role of External Fixation in Unstable and Complex Pelvic Fractures

The treatment of pelvic fractures has undergone a change over the past few years. As there seems to be a trend away from external towards internal fixation, the goal of this study was to investigate whether the use of an external fixator is still a standard procedure for the initial as well as - if necessary - for the definitive treatment of complex and unstable pelvic injuries.

During a period of five years at the Level I Trauma Center, an external fixator was applied in 28 (11%) out of 236 pelvic ring fracture cases. The common indications were open fractures, complex fractures and multiple injuries with hemodynamic instability. Hemorrhage control, fracture stabilization and infection prophylaxis in cases of open fracture were achieved by variable placement and fixation of Schanz screws. In some cases, the assembly of a hybrid combined with internal osteosynthesis was used to increase stability.

Of the 28 patients, 20 survived, while eight (28.6%) died in the course of treatment due to fatal hemorrhage, craniocerebral trauma, multi-organ failure and sepsis. A satisfactory result (anatomical and functional outcome) was achieved in 16 of the 20 cases (80%). The remaining four (20%) suffered from serious complications, the majority of them caused by the initial type of injury.

The use of the external fixator for the initial and in some cases for the definitive fixation of unstable and complex pelvic injuries with hemodynamic instability is still a successful treatment of multiply injured patients.