Acute Mortality Associated With Injuries to the Pelvic Ring

Riemer, Barry L.; Butterfield, Spencer L.; Diamond, Daniel L.; Young, Joseph C.; Raves, John J.; Cottington, Eric; Kislan, Kira

doi:10.1097/00005373-199311000-00003

Cited by 216 publications

(21 citation statements)

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“…Minimally invasive techniques are increasingly reported in the literature as an alternative to traditional external fixators [1]. External fixation has typically been used temporarily for unstable pelvic fractures in damage control situations with haemodynamic instability, although their application can be definitive management [2, 3]. External fixation has a number of disadvantages, with pin site infection being reported in 2–50 % and osteomyelitis in 0–7 % [2, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures

et al. 2016

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BackgroundExternal fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod.MethodsA single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications.ResultsTwenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44–65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar.ConclusionsMinimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised.Trial registration ACTRN12616001421426. Registered 12 October 2016. Retrospectively registered.

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Section: Introductionmentioning

confidence: 99%

A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures

et al. 2016

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“…Both the pelvic external fixator and circumferential compression devices have been reported to be effective in the early stabilization of unstable pelvic injuries [11, 28–30]. In the present series, the external fixator or the pelvic binder was used as an emergency procedure in pelvic fractures associated with an increase in the pelvic volume and/or severe vertical instability.…”

Section: Discussionmentioning

confidence: 93%

Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors

Lindahl

Handolin

Söderlund

et al. 2012

Eur J Trauma Emerg Surg

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PurposeThe control of arterial bleeding associated with pelvic ring and acetabular fractures (PRAF) remains a challenge for emergency trauma care. The aim of the present study was to uncover early prognostic mortality-related factors in PRAF-related arterial bleedings treated with transcatheter angiographic embolization (TAE).MethodsForty-nine PRAF patients (46 pelvic ring and three acetabular fractures) with arterial pelvic bleeding controlled with TAE (within 24 h) were evaluated.ResultsAll large arterial disruptions (n = 7) were seen in type C pelvic ring injuries. The 30-day mortality in large vessel (iliac artery) bleeding was higher (57 %) than in medium- or small-size artery bleeding (24 %). Overall 30-day mortality was 29 %. No statistically significant difference in the first laboratory values between the survivors and nonsurvivors was found. However, after excluding patients dying of head injuries (n = 5), a reasonable cut-off value was identified for the base excess (BE; lower than −10 mmol/l) obtained on admission.ConclusionsPRAF patients with exsanguinating bleeding from the large pelvic artery have the worst prognosis. Very low BE values (<−10.0 mmol/l) on admission for exsanguinating patients have a negative predictive value for survival, thus anticipating a poor outcome in bleeding controlled with TAE only and an increased risk of death. In critical cases, an aggressive bleeding control protocol prompts extraperitoneal pelvic packing prior to TAE. PRAF-related rupture of the external iliac artery is rare and indicates surgical techniques in controlling and restoring blood supply to the lower leg.

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“…It is known that, in the treatment of pelvic ring injuries, early mobilization significantly reduces posttraumatic complications and morbidity [5]. In fractures with intact posterior sacroiliac and sacro-tuberous ligaments (like LC II and APC II), posterior stabilization has to be postponed in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…With external fixation, reduction of the inner pelvic diameter can be achieved within minutes, thereby limiting venous haemorrhage into the lesser pelvis [3]. Besides this direct effect on the extent of blood loss in the acute situation, external fixation reduces motion between the pelvic fragments and thus helps to maintain haemostasis during the first days after the trauma [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation

Osterhoff

Tiziani

Ferguson

et al. 2014

BMC Musculoskelet Disord

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BackgroundAlthough useful in the emergency treatment of pelvic ring injuries, external fixation is associated with pin tract infections, the patient’s limited mobility and a restricted surgical accessibility to the lower abdomen. In this study, the mechanical stability of a subcutaneous internal anterior fixation (SIAF) system is investigated.MethodsA standard external fixation and a SIAF system were tested on pairs of Polyoxymethylene testing cylinders using a universal testing machine. Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1 Hz with sinusoidal lateral compression/distraction (+/−50 N) and torque (+/− 0.5 Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700 and 900 cycles.ResultsThere was no significant difference in translational stiffness between the SIAF and the standard external fixation when compared at 500 (p = .089), 700 (p = .081), and 900 (p = .266) cycles. Rotational stiffness observed for the SIAF was about 50 percent higher than the standard external fixation at 300 (p = .005), 500 (p = .020), and 900 (p = .005) cycles. No loosening or failure of the rod-pin/rod-screw interfaces was seen.ConclusionsIn comparison with the standard external fixation system, the tested device for subcutaneous internal anterior fixation (SIAF) in vitro has similar translational and superior rotational stiffness.

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Acute Mortality Associated With Injuries to the Pelvic Ring

Cited by 216 publications

References 0 publications

A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures

A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures

Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors

Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation

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