Complications of temporary and definitive external fixation of pelvic ring injuries

Mason, William T.; Khan, S.N.; James, C.L.; Chesser, T.J.S.; Ward, A.J.

doi:10.1016/j.injury.2004.11.016

Cited by 129 publications

(100 citation statements)

References 16 publications

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“…Many devices have been used acutely to accomplish this goal, including pelvic binders and circumferential sheets in both the pre-hospital setting and resuscitation bay, to external fixation and C-clamp fixation. The reduction in pelvic volume causes a tamponade for the pelvic haematoma and venous plexus bleeding, minimises movement at the fracture sites to prevent clot disruption, and ultimately aids in resuscitation [2][3][4][5]8]. External fixation is preferred in the acute setting due to its relative ease and speed of application [2][3][4][5]8].…”

Section: Discussionmentioning

confidence: 99%

“…The reduction in pelvic volume causes a tamponade for the pelvic haematoma and venous plexus bleeding, minimises movement at the fracture sites to prevent clot disruption, and ultimately aids in resuscitation [2][3][4][5]8]. External fixation is preferred in the acute setting due to its relative ease and speed of application [2][3][4][5]8]. However, complications associated with external fixation are numerous [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…This improves to 0 to 8 % when combined with posterior fixation [7,8]. An anterior pelvic external fixator limits patient mobility, especially when sitting and when being rolled from side to side.…”

Section: Introductionmentioning

confidence: 99%

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Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone

Vigdorchik

Esquivel

Jin

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the biomechanical stability and compressive forces across the sacroiliac (SI) joint of an anterior internal fixator compared to the femoral distractor and external fixator for vertically unstable pelvic fractures. Methods Five composite pelvises with a simulated APC type III injury fixed with a femoral distractor, external fixator, or anterior internal fixator were tested. A pressuresensitive film (Tekscan) was placed in the disrupted SI joint recording the magnitude of force. Then, in a single-leg stance model (Instron machine), a load was applied through the sacrum. We recorded displacement at the pubic symphysis and SI joint using high-speed video. Peak load and displacement were measured, and axial stiffness was calculated. Values were compared using a Student's t-test (p<0.05). Results The SI joint was compressed significantly (p < 0.001) more using the anterior internal fixator (18.9 N) and femoral distractor (18.6 N) than the two-pin external fixator (2.5 N). There was no significant difference between the anterior internal fixator and the femoral distractor in displacement at the SI joint. The pubic symphysis displaced less with the femoral distractor than the anterior internal fixator (5.5 mm vs. 4.1 mm; p<0.05). Conclusions The anterior pedicle screw internal fixator allows for indirect compression across the sacroiliac joint that is superior to two-pin external fixation and comparable to the femoral distractor. The anterior internal fixator may be an option for temporary anterior pelvic fixation in situations where external fixation or the femoral distractor have otherwise been used.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone

Vigdorchik

Esquivel

Jin

et al. 2013

International Orthopaedics (SICOT)

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“…Second, there is no or minimal hardware prominence, in contradistinction to an external fixator, and fewer difficulties with clothing wear, sitting in a chair, sexual intercourse, skin impingement, and surgical site pain [13,31]. Other drawbacks to external fixation include pin tract infections, fixator loosening, limited surgical access to the abdomen, and reoperations [14,15,17,23,24,30].…”

Section: Discussionmentioning

confidence: 99%

“…External fixation methods for pelvic ring injuries are well described [5,10,15,19,23,25,30]. Anterior ring external fixation has been described as a way to complement posterior ring fixation [11,20,27].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

Hiesterman

Hill

Cole

2012

Clinical Orthopaedics &Amp; Related Research

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Background Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis. Description of Technique An incision is made over each anterior iliac crest and a 6-to 8-cm incision is centered over the symphysis. Either a locking reconstruction plate or a spinal rod is placed through a subcutaneous tunnel overlying the external oblique fascia in the subcutaneous tissue, and fixation into the iliac crest and pubis is achieved to effect stability. Methods A randomized controlled trial comparing anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) for unstable pelvic ring injuries was begun in October 2010. Patients with unstable pelvic ring injuries were enrolled and followed with respect to fracture reduction, surgical pain, complications, and functional outcome scores.

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Surgical anatomy for pelvic external fixation

et al. 2008

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Pelvic external fixators have a high rate of reported complications, most of which relate to pin placement. In this descriptive study, we analyzed the morphology of the ilium in cadaveric specimens and compared these with the measures obtained from normal human pelvic computer tomograph scans, and how these related to each of the three basic configurations of pin positioning for the external fixation of a pelvis: anterosuperior (Slätis type), anteroinferior (supra-acetabular), and subcristal. The irregular shape and size of the iliac wing and the abdominal wall overlying the pin's insertion site could hinder accurate placement of anterosuperior pins. Potential disadvantages of the use of anteroinferior pins was found related to the deep location of the anterior inferior iliac spine, interference with the hip flexion area, risk of hip joint penetration, and the variable obliquity of the ilium. As subcristal pins are positioned between two superficial bony landmarks of the iliac crest, our findings suggest that they are more likely to have a correct placement and avoid complications.

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Complications of temporary and definitive external fixation of pelvic ring injuries

Cited by 129 publications

References 16 publications

Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone

Anterior internal fixator versus a femoral distractor and external fixation for sacroiliac joint compression and single stance gait testing: a mechanical study in synthetic bone

Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

Surgical anatomy for pelvic external fixation

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