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Surgical Treatment of Pelvic Ring Injuries

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European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 13))

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Abstract

The treatment of unstable pelvic ring fractures is a major challenge even without vascular compromise, as these fractures are rare injuries and the caseload is small at smaller hospitals. Therefore the definitive treatment of unstable pelvic ring and acetabular fractures should be centralized at the biggest trauma hospitals. Good reduction together with proper stabilization allows early mobilization, prevents complications, and, thereby, leads to a short hospital stay and an early start of rehabilitation. In type C pelvic ring injuries internal fixation of displaced and unstable rami fractures and symphyseal disruptions in conjunction with posterior fixation seems to yield better stability for the whole pelvic ring. Several authors have associated good reduction result with favourable long-term results. It is also documented that the permanent lumbosacral plexus injury is a strong prognostic factor. The clinical results suggest that special attention should be paid on pre-operative planning, reduction of the fracture, decompression of the nerve roots, and stable internal fixation of all main fracture components.

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References

  1. Alonso JE, Jackson L, Burgess AR, Browner BD (1996) The management of complex orthopedic ­injuries. Surg Clin North Am 76:879–903

    Article  PubMed  CAS  Google Scholar 

  2. Bircher MD (1996) Indications and techniques of external fixation of the injured pelvis. Injury 27(Suppl 2):S-B3–S-B19

    Google Scholar 

  3. Burgess AR, Eastridge BJ, Young JWR, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30:848–856

    Article  PubMed  CAS  Google Scholar 

  4. Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoro V, McAninch JW (2004) Consensus on genitourinary trauma. Consensus statement on urethral trauma. BJU Int 93:1195–1202

    Article  PubMed  CAS  Google Scholar 

  5. Cole JD, Bolhofner BR (1994) Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach: description of operative technique and preliminary treatment results. Clin Orthop 305:112–123

    PubMed  Google Scholar 

  6. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem: retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81

    PubMed  CAS  Google Scholar 

  7. Ebraheim NA, Rusin JJ, Coombs RJ, Jackson WT, Holiday B (1987) Percutaneous computer tomography-stabilization of pelvic fracture: preliminary report. J Orthop Trauma 1:197–204

    Article  PubMed  CAS  Google Scholar 

  8. Ertel W, Keel M, Eid K, Platz A, Trentz O (2001) Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 15:468–474

    Article  PubMed  CAS  Google Scholar 

  9. Evers BM, Cryer HM, Miller FB (1989) Pelvic ­fracture hemorrhage. Priorities in management. Arch Surg 124:422–424

    Article  PubMed  CAS  Google Scholar 

  10. Gaarder C, Naess PA, Christensen EF, Hakala P, Handolin L, Heier HE, Ivancev K, Johansson P, Leppäniemi A, Lippert F, Lossius HM, Opdahl H, Pillgram-Larsen J, Røise O, Skaga NO, Søreide E, Stensballe J, Tønnessen E, Töttermann A, Örtenwall P, Östlund A (2008) Scandinavian guidelines – “the massively bleeding patient”. Scand J Surg 97:15–36

    PubMed  CAS  Google Scholar 

  11. Ghanayem AJ, Stover MD, Goldstein JA, Bellon E, Wilber JH (1995) Emergent treatment of pelvic fractures. Comparison of methods for stabilization. Clin Orthop Relat Res 318:75–80

    PubMed  Google Scholar 

  12. Gilliland MD, Ward RE, Barton RM, Miller PW, Duke JH (1982) Factors affecting mortality in pelvic fractures. J Trauma 22:691–693

    Article  PubMed  CAS  Google Scholar 

  13. Goldstein A, Phillips T, Sclafani SJA, Scalea T, Duncan A, Goldstein J, Panetta T, Shafton G (1986) Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma 26:325–333

    Article  PubMed  CAS  Google Scholar 

  14. Gomez RG, Ceballos L, Coburn M, Corriere JN, Dixon CM, Lobel B, McAninch J (2004) Consensus on genitourinary trauma. Consensus statement on bladder injuries. BJU Int 94:27–33

    Article  PubMed  Google Scholar 

  15. Gunterberg B, Goldie I, Slätis P (1978) Fixation of pelvic fractures and dislocations: an experimental study on the loading of pelvic fractures and sacro-iliac dislocations after external compression fixation. Acta Orthop Scand 49:278–286

    Article  PubMed  CAS  Google Scholar 

  16. Gylling SF, Ward RE, Holcroft JW, Bray TJ, Chapman MW (1985) Immediate external fixation of unstable pelvic fractures. Am J Surg 150:721–724

    Article  PubMed  CAS  Google Scholar 

  17. Gänsslen A, Hildebrand F, Pohlemann T (2012) Management of hemodynamic unstable patients “in extremis” with pelvic ring fractures. Acta Chir Orthop Traumatol Cech 79(3):193–202

    PubMed  Google Scholar 

  18. Handolin L, Leppäniemi A, Vihtonen K, Lakovaara M, Lindahl J (2006) Finnish trauma audit 2004: current state of trauma management in Finnish hospitals. Injury 37:622–625

    Article  PubMed  CAS  Google Scholar 

  19. Henry SM, Tornetta P III, Scalea TM (1997) Damage control for devastating pelvic and extremity injuries. Surg Clin North Am 77:879–895

    Article  PubMed  CAS  Google Scholar 

  20. Hirvensalo E, Lindahl J, Böstman O (1993) A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res 297:28–32

    PubMed  Google Scholar 

  21. Hirvensalo E, Lindahl J, Kiljunen V (2007) Modified and new approaches for pelvic and acetabular surgery. Injury 38:431–441

    Article  PubMed  Google Scholar 

  22. Kellam JF, McMurtry RY, Paley D, Tile M (1987) The unstable pelvic fracture: operative treatment. Orthop Clin North Am 18:25–41

    PubMed  CAS  Google Scholar 

  23. Kellam JF (1989) The role of external fixation in pelvic disruptions. Clin Orthop Relat Res 241:66–82

    PubMed  Google Scholar 

  24. Lansinger O, Karlsson J, Berg U, Måre K (1984) Unstable fractures of the pelvis treated with a trapezoid compression frame. Acta Orthop Scand 55:325–329

    Article  PubMed  CAS  Google Scholar 

  25. Leighton RK, Waddell JP, Bray TJ, Chapman MW, Simpson L, Martom RB, Sharkey NA (1991) Biomechanical testing of new and old fixation devices for vertical shear fractures of the pelvis. J Orthop Trauma 5:313–317

    Article  PubMed  CAS  Google Scholar 

  26. Lindahl J, Hirvensalo E, Böstman O, Santavirta S (1999) Failure of reduction with an external fixator in the treatment of injuries of the pelvic ring: long-term evaluation of 110 patients. J Bone Joint Surg Br 81B:955–962

    Article  Google Scholar 

  27. Lindahl J, Hirvensalo E (2005) Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop 76(5):667–678

    Article  PubMed  Google Scholar 

  28. Lynch TH, Martinez-Pineiro L, Plas E, Serafetinides E, Turkeri L, Santucci RA, Hohenfellner M (2005) EAU guidelines on urological trauma. Eur Urol 47:1–15

    Article  PubMed  Google Scholar 

  29. Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83–97

    PubMed  Google Scholar 

  30. Matta JM (1996) Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res 329:88–96

    Article  PubMed  Google Scholar 

  31. McLaren AC, Rorabeck CH, Halpenny J (1990) Long-term pain and disability in relation to residual deformity after displaced pelvic ring fractures. Can J Surg 33:492–494

    PubMed  CAS  Google Scholar 

  32. Mears DC, Fu F (1980) External fixation in pelvic fractures. Orthop Clin North Am 11:465–479

    PubMed  CAS  Google Scholar 

  33. Mucha P, Welch TJ (1988) Hemorrhage in major pelvic fractures. Surg Clin North Am 68:757–773

    PubMed  Google Scholar 

  34. Papakostidis C, Giannoudis PV (2009) Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury 40(S4):553–561

    Google Scholar 

  35. Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV (2009) Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop 33:329–338

    Article  PubMed  CAS  Google Scholar 

  36. Pohlemann T, Bosch U, Gänsslen A, Tscherne H (1994) The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res 305:69–80

    Article  PubMed  Google Scholar 

  37. Pohlemann T, Gänsslen A, Schellwald O, Culemann U, Tscherne H (1996) Outcome after pelvic ring injuries. Injury 27(Suppl 2):S-B31–S-B38

    Google Scholar 

  38. Ponsen KJ, van Dijke GAH, Joosse P, Snijders CJ (2003) External fixators for pelvic fractures. Comparison of the stiffness of current systems. Acta Orthop Scand 74:165–171

    Article  PubMed  Google Scholar 

  39. Ragnarsson B, Olerud C, Olerud S (1993) Anterior square-plate fixation of sacroiliacdisruption. 2–8 years follow-up of 23 consecutive cases. Acta Orthop Scand 64:138–142

    PubMed  CAS  Google Scholar 

  40. Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T (1979) Operative control of massive haemorrhage in comminuted pelvic fractures. Int Orthop 3:141–144

    Article  PubMed  CAS  Google Scholar 

  41. Rothenberger DA, Fischer RP, Strate RG, Velasco R, Perry JF Jr (1978) The mortality associated with pelvic fractures. Surgery 84:356–361

    PubMed  CAS  Google Scholar 

  42. Routt MLC, Simonian PT, Grujic L (1995) The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic disruptions: a new technique. J Orthop Trauma 9:35–44

    Article  PubMed  Google Scholar 

  43. Routt MLC, Simonian PT (1996) Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop Relat Res 329:121–128

    Article  PubMed  Google Scholar 

  44. Routt ML, Simonian PT (1996) Internal fixation of pelvic ring disruptions. Injury 27(Suppl 2):S-B20–S-B30

    Google Scholar 

  45. Slätis P, Karaharju E (1975) External fixation of the pelvic girdle with a trapezoid compression frame. Injury 7:53–56

    Article  PubMed  Google Scholar 

  46. Slätis P, Karaharju E (1980) External fixation of unstable pelvic fractures: experiences in 22 patients treated with a trapezoid compression frame. Clin Orthop Relat Res 151:73–80

    PubMed  Google Scholar 

  47. Steiner CL, Trenz O, Labler L (2008) Management of Morel-Lavallee lesion associated with pelvic and/or acetabular fractures. Eur J Trauma Emerg Surg 34:554–560

    Article  Google Scholar 

  48. Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70B:1–12

    Google Scholar 

  49. Tile M (1995) Fractures of the pelvis and acetabulum, 2nd edn. Williams & Wilkins, Baltimore

    Google Scholar 

  50. Tornetta P III, Matta JM (1996) Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res 329:186–193

    Article  PubMed  Google Scholar 

  51. Tscherne H, Regel G (1996) Care of the polytraumatised patient. J Bone Joint Surg Br 78B:840–852

    Google Scholar 

  52. Tseng S, Tornetta P III (2006) Percutaneous management of Morel-Lavallee lesions. J Bone Joint Surg Am 88:92–96

    Article  PubMed  Google Scholar 

  53. Tuovinen H, Söderlund T, Lindahl J, Laine T, Åström P, Handolin L (2011) Severe pelvic fracture-related bleeding in pediatric patients: does it occur? Eur J Trauma Emerg Surg. doi:10.1007/s00068-011-0140-3 [Published online August]

  54. Ward EF, Tomasin J, Vander Griend RA (1987) Open reduction and internal fixation of vertical shear pelvic fractures. J Trauma 27:291–295

    Article  PubMed  CAS  Google Scholar 

  55. Wild JJ, Hanson GW, Tullos HS (1982) Unstable fractures of the pelvis treated by external fixation. J Bone Joint Surg Am 64A:1010–1020

    Google Scholar 

  56. Wolinsky PR (1997) Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin North Am 28:321–329

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Pelvis and Lower Extremity Trauma Unit, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, 00260, Finland

    Jan Lindahl MD

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  1. Jan Lindahl MD
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Correspondence to Jan Lindahl MD .

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  1. Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, United Kingdom

    George Bentley

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Lindahl, J. (2013). Surgical Treatment of Pelvic Ring Injuries. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_9

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  • DOI: https://doi.org/10.1007/978-3-642-36149-4_9

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