External Fixation

Abstract

Biomechanical studies have demonstrated that the supraacetabular external fixator does not provide a sufficient stability and retention for fractures of the posterior pelvic ring. Under certain circumstances, it can be used for definitive treatment of transpubic fractures and leads to a fast reduction of pain. In fragility fractures that involve both the posterior and the anterior pelvic ring, an external fixator can be applied as a supplement to a posterior osteosynthesis in order to increase the overall stability of the pelvic ring. In osteoporotic bone, the risk of pin loosening is increased. Furthermore, pin track infection rates of up to 30% have been reported. The Schanz’ screws are inserted through the anterior inferior iliac spines and oriented approximately 20° cranially and 30° medially. They should be inserted as far as possible to achieve a maximum of stability. A curved carbon rod, which connects the screws, minimizes impairment for the patient and facilitates radiological examinations. An unhindered passage of the Schanz’ screws through the skin must be assured. Daily wound care of the skin incisions including changing dressings is mandatory. Patients are allowed to mobilize out of the bed with weight bearing as tolerated. The time-point of removal is depending of the morphology and displacement of the anterior pelvic ring fracture and of clinical and radiological signs of bone healing.