Abstract
High-energy pelvic ring fractures are life-threatening injuries. A team approach, involving general trauma surgeons, orthopaedic surgeons, and other specialists, is required during the patient’s initial evaluation and resuscitation. Hemodynamic instability and associated hemorrhage require immediate action to save the patient’s life. Temporary pelvic stabilization can be achieved with a sheet, pelvic binder, military antishock trousers, C-clamp, or external fixator. In patients with continued hemodynamic instability, pelvic packing and/or angiography may also be required. The treatment algorithm for patients with pelvic ring injuries and hemodynamic instability should be standardized based on the institutions capabilities. Various options are available for definitive surgical fixation to reestablish the anatomic integrity of the pelvic ring, and restore the patient to full function.
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References
Tile M, editor. Fractures of the pelvic and acetabulum. 2nd ed. Baltimore: Williams & Wilkins; 1995.
Kellam JF, Browner BD. Fractures of the pelvic ring. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma. Philadelphia: W.B. Saunders; 1992.
Olson SA, Burgess A. Classification and initial management of patients with unstable pelvic ring injuries. Instr Course Lect. 2005;54:383–93.
Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70(1):1–12.
Tile M. Acute pelvic fractures: I: Causation and classification. J Am Acad Orthop Surg. 1996;4(3):143–51.
Burgess AR, Eastridge BJ, Young JWR, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30(7):848–56.
Dalal SA, Burgess AR, Siegel JH, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements and outcome. J Trauma. 1989;29(7):981–1000.
Routt Jr ML, Falicov A, Woodhouse E, Schildhauer TA. Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma. 2002;16:45–8.
Croce MA, Magnotti LJ, Savage SA, Wood II GW, Fabian TC. Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg. 2007;204:935–42.
Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma. 1993;35:671–7.
Grimm MR, Vrahas MS, Thomas KA. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma. 1998;44:454–9.
Ganz R, Krushell RJ, Jakob RP, KĂ¼ffer J. The antishock pelvic clamp. Clin Orthop Relat Res. 1991;267:71–8.
Archdeacon MT, Hiratzka J. The trochanteric C-clamp for provisional pelvic stability. J Orthop Trauma. 2006;20: 47–51.
Eastridge BJ, Starr A, Minei JP, O’Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–51.
Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC. External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma. 2003;54:437–43.
Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed III JF. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma. 1997;43:395–9.
Balogh Z, Caldwell E, Heetveld M, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005;58:778–82.
Yasumura K, Ikegami K, Kamohara T, Nohara Y. High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture. J Trauma. 2005;58:985–90.
Pohlemann T, Bosch U, Gänsslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res. 1994;305:69–80.
Smith WR, Moore EE, Osborn P, et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and a description of technique. J Trauma. 2005;59: 1510–4.
Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma. 2007;62:834–42.
Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma. 2008;22:373–8.
Ponson KJ, Hoek van Dijke GA, Joosse P, Snijders CJ, Agnew SG. Improvement of external fixator performance in type C pelvic ring injuries by plating of the pubic symphysis: an experimental study on 12 external fixators. J Trauma. 2002;53:907–12.
Routt Jr ML, Simonian PT, Grujic L. The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique. J Orthop Trauma. 1995;9:35–44.
Suzuki T, Hak DJ, Zran BH, et al. Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures. Injury: Int J Care Injured. 2009;40:405–9.
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© 2011 Springer-Verlag Berlin Heidelberg
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Hak, D.J., Nork, S.E. (2011). Management of Pelvic Ring Injuries. In: Pape, HC., Sanders, R., Borrelli, Jr., J. (eds) The Poly-Traumatized Patient with Fractures. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-17986-0_10
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DOI: https://doi.org/10.1007/978-3-642-17986-0_10
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