Open pelvic fractures: epidemiology, current concepts of management and outcome

Grotz, M.; Allami, Mohamad; Harwood, Paul; Pape, Hans-Christian; Krettek, Christian; Giannoudis, Peter V.

doi:10.1016/j.injury.2004.05.029

Cited by 270 publications

(265 citation statements)

References 105 publications

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“…In cases of emergency and haemodynamic instability, the pelvic clamp can provide temporary stabilisation [3,4], while there are different options for the definitive repair of the posterior pelvic ring (depending on fracture morphology), such as lumbopelvic and iliolumbar support using a system of rods and screws [5], a sacroiliac screw connection [6] or sacral screw and plates osteosyntheses in various configurations [7,8]. Furthermore, the transiliacal internal fixator (TIFI) represents another stable and minimally invasive option [9,10].…”

Section: Introductionmentioning

confidence: 99%

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

Müller

Stosiek

Zellner

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF). Methods Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated. Results Overall, three patients (8.3 %) died, and 31 patients (86 %) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97 %) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5 % of the patients, and a fair or poor for 35.5 %. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population. Conclusions The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future.

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Section: Introductionmentioning

confidence: 99%

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

Müller

Stosiek

Zellner

et al. 2013

International Orthopaedics (SICOT)

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“…Open fractures of the pelvis are associated with anorectal trauma in 17-64% [105,106,107,108] according to a review by Grotz et al [109]. In our study the incidence of rectum injuries associated with high-energy pelvic ring disruptions was 2%.…”

Section: Discussionsupporting

confidence: 51%

“…For high risk patients, even in case of a negative finding, other diagnostic options like contrast enema or rectoscopy/sigmoidoscopy might be also considered. A recent review on open pelvic fractures by Grotz et al [109] resulted in similar recommendations regarding diagnosis of anorectal injuries associated. Some authors questioned the use of routine performance of PR examination in the secondary survey of the trauma victim in both adults [110,111] and children [112] resulting in the recent change of the ATLS guidelines [16].…”

Section: Discussionmentioning

confidence: 94%

Acute management of high-energy pelvic ring injuries

Tóth¹

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“…16 In some studies that favor primary definitive stabilization, the data suggest that early total care (ETC) had only been performed in patient groups with lower injury severity scores. [97][98][99] To classify patients in a critical condition, general surgeons use the term ''triad of death,'' 81 consisting of the degree of shock, hypothermia, and coagulopathy. 109 Although these factors have been largely tested in patients with penetrating injuries, 110 we confirmed that they are also relevant for patients with blunt trauma and appear to be feasible for use in the decision-making process in the emergency room.…”

Section: Resultsmentioning

confidence: 99%

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Pape

2008

Journal Orthopaedic Research

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In the treatment of polytrauma patients, multiple studies have shown how the timing and the type of the initial surgery of long bone fractures influence the incidence of systemic complications. Database analyses documented that unduly long surgical procedures undertaken early after trauma increase the risk of acute respiratory distress syndrom (ARDS), especially when femoral shaft fractures are stabilized. Animal research and prospective clinical studies also support the fact that the type of stabilization of a femoral shaft fracture may influence the systemic response to trauma. Reamed intramedullary reaming and nailing for a femoral shaft fracture is associated with an increased risk of pulmonary fat embolization from the medullary canal. This can result in pulmonary compromise if certain cofactors are also present. Modified reamers have been developed to reduce this side effect. The mediating effects are immunologic changes, varying according to the magnitude of the surgical procedure. Pro-inflammatory markers (e.g., Interleukins) may be used to assess the inflammatory response to injury as well as the magnitude of surgery and the systemic impact induced by surgery. Serum levels of such markers can be used clinically to tailor the amount of surgery that is performed to the clinical condition of the patient. The potentially negative impact of excessive surgery in high-risk patients can be avoided by using a new grading system for the assessment of the clinical status of the injured patient. Most recently, a large prospective randomized multicenter study has documented that this grading system is effective for identifying these borderline patients, and that in the borderline patient a staged surgical approach, such as temporary femoral stabilization with an external fixator, reduces the incidence of systemic complications. This work has changed the surgical management of multiply injured patients toward an approach that is tailored to the clinical condition of the patient, as indicated by well-defined clinical parameters as well as objective measurements of serum cytokine levels. ß

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Open pelvic fractures: epidemiology, current concepts of management and outcome

Cited by 270 publications

References 105 publications

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

Acute management of high-energy pelvic ring injuries

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

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