Emergency pelvic stabilization in critically unstable patients.

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Anatomy

Background:

• Immediate posterior pelvic ring stabilization is crucial for pelvic packing in trauma patients.
• Patients in extremis often lack adequate positioning or imaging for stabilization.
• Percutaneous fixation offers a viable alternative for rapid stabilization.

Purpose of the Study:

• To evaluate the feasibility of percutaneous K-wire application to the posterior pelvic ring without intraoperative imaging.
• To assess the accuracy of K-wire placement using classical landmarks in cadavers.
• To determine the safety and efficacy of this technique in simulated emergency scenarios.

Main Methods:

• Ten human adult whole-body cadavers were used for the study.
• Percutaneous 2.8 mm K-wire insertion into the posterior pelvic ring was performed using classical iliosacral screw fixation landmarks.
• No intraoperative imaging was used; post-insertion radiography confirmed wire positioning.

Main Results:

• The K-wire was placed in the expected anatomic position in 80% of hemipelves across all radiographic views.
• Malpositions were typically anterior relative to the sacrum.
• The complication rate was comparable to malpositioned pelvic C-clamp pins.

Conclusions:

• Percutaneous K-wire fixation of the posterior pelvic ring is feasible without intraoperative imaging, utilizing standard anatomical landmarks.
• This technique is a safe and effective option for stabilizing pelvic fractures in patients in extremis.
• The study confirms the reliability of this method in achieving adequate stability with minimal risk.