Pelvic ring injuries: current concepts of management


Authors: Martin Salášek;  Tomáš Pavelka
Authors‘ workplace: Univerzita Karlova v Praze, Lékařská fakulta a FN Plzeň, Klinika ortopedie a traumatologie pohybového ústrojí
Published in: Čas. Lék. čes. 2011; 150: 433-437
Category: Review Articles

Overview

Pelvic ring injuries occur at any age. Most injuries to the pelvis are due to high-energy trauma, these injuries are therefore associated with abdominal, thoracic and head injuries. Unstable disruption of the pelvic ring has been often coupled with massive or life-threatening haemorrhage. The goal of the prehospital management is to keep airway open, start oxygen therapy, fluid replacement therapy and apply appropriate immobilization device. On admission of hemodynamically stable patients CT is preferred, for hemodynamically unstable the plain antero-posterior pelvis radiograph and ultrasound. To achieve hemodynamic stability, the pelvic C-clamp or external fixator should be applied. Pelvic packing or ligation of internal iliac artery is performed in the presence of arterial bleeding. In the acute period minimally invasive internal fixation with closed reduction should be used (transiliacal internal fixator, iliosacral screws). The open reduction with internal fixation can be performed after stabilization of the general state of health (after about 5 days), pelvic plates and spinopelvic fixation are appropriate for this approach. To recover the patient into normal life, bed rest and rehabilitation follows after surgical treatment.

Key words:
pelvic ring injuries, C-clamp, internal fixation, minimally invasive approach.


Sources

1. Višňa P, Hoch J, et al. Traumatologie dospělých. Praha: Maxdorf 2004.

2. Šnajdauf J, Cvachovec K, Trč T, et al. Dětská traumatologie. Praha: Galén 2002.

3. Chmelová J, Džupa P, Pavelka T, et al. Diagnostika zlomenin pánve a acetabula Praha: Galén 2010.

4. Rowe SA, Sochor MS, Staples KS, et al. Pelvic ring fractures: Implications of vehicle design, crash type and occupant characteristics. Surgery 2004; 136(4): 842–847.

5. Chem TW, Yang ZG, Dong ZH, et al. Pelvic crush fractures in survivors of the Sichuan earthquake evaluated by digital radiography and multidetector computed tomography. Skeletal Radiol 2010; 39(11): 1117–1122.

6. Lee C, Porter, K. The prehospital management of pelvic fractures. Emerg Med J 2007; 24: 130–133.

7. Durkin A, Sagi H C, Durham R, Flint, L. Contemporary management of pelvic fractures. The American Journal of Surgery 2006; 192: 211–223.

8. Grotz MRW, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. Int J Care Injured 2005; 36: 1–13.

9. Slater SJ, Barron, DA. Pelvic fractures – A guide to classification and management. European Journal of Radiology 2010; 74: 16–23.

10. Tiemann AH, Böhme J, Josten C. Anwendung der Beckenzwinge beim poly-traumatisierten Patienten mit instabilem Becken Modifizierte Technik – Gefahren – Probleme. Orthopäde 2006; 35: 1225–1236.

11. Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. Int J Care Injured 2009; 40S4: S53–S61.

12. White ChE Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury, Int. J. Care Injured 2009; 40: 1023–1030.

13. Yoon W, Kim JK, Jeong YY, et al. Pelvic Arterial Hemorrhagie n Patients with Pelvic Fractures: detection with Contrast – enhanced CT. RadioGraphics 2004; 24: 1591–1606.

14. Westhoff J, Laurer H, Wutzler S, et al. Interventionelle Notfallembolisation bei schweren Beckenfrakturen mit arterieller Blutung. Unfallchirurg 2008; 111: 821–828.

15. Sadri H, Nguyen-Tang T, Stern R, et al. Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption. Arch Orthop Trauma Surg 2005; 125: 443–447.

16. Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury 2009; 40(4): 343–353.

17. Wirth GJ, Peter R, Poletti P-A, Iselin ChE. Advances in the management of blunt traumatic bladder rupture: experience with 36 cases. B J U International 2010; 106: 1344–1349.

18. Kuttner M, Klaiber A, Lorenz T. Der subkutane ventrale Fixateur interne (SVFI) am Becken. Unfallchirurg 2009; 112: 661–669.

19. Simonian PT, Chip Routt Jr. ML, Harrington RM, Tencer AF. The unstable iliac fracture: a biomechanical evaluation of internal fixation. Injury 1997; 28: 469–475.

20. Varga E, Hearn T, Powell J, Tile M. Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. Injury 1995; 26(2): 75–80.

21. Füchtmeier B, Maghsudi M, Neumann C, et al. Die minimal-invasive Stabilisierung des dorsalen Beckenrings mit dem transiliakalen Fixateur interne (TIFI).Operative Technik und erste klinische Ergebnisse. Unfallchirurg 2004; 107: 1142–1151.

22. Kraemer W, Hearn T, Tile M, Powell J. The effect of thread length and location on extraction strengths of iliosacral lag screws. Injury 1994; 1: 5–9.

23. Gorczyca JT, Varga E, Woodside T, et al. The strength of iliosacral lag screws and transiliac bars in the fixation of vertically unstable pelvic injuries with sacral fractures. Injury 1996; 8: 561–564.

24. Tosounidis G, Culemann U, Wirbel R, et al. Die perkutane transiliosakrale Zugschraubenosteosynthese des hinteren Beckenrings (Erhöhte Sicherheit durch Standardisierung von Visualisierung und Technik). Unfallchirurg 2007; 110: 669–674.

25. Mendel1 T, Kuhn P, Wohlrab1 D, Brehme K. Minimal-invasive Stabilisierung einer bilateralen Sakrumfraktur mit lumbopelviner Dissoziation. Unfallchirurg 2009; 112: 590–595.

26. Rosenberger RE, Dolati B, Larndorfer R, et al. Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg 2010; 130: 223–230.

27. Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries a case series. BMC Musculoskelet Disord 2010; 11: 153.

28. Eid K, Keel M, Keller A, Ertel W, Trentz O. Einfluss der Sakrumfraktur auf das funktionelle Langzeitergebnis von Beckenringverletzungen. Unfallchirurg 2005; 108: 35–42.

29. Sagi HC. Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures. J Orthop Trauma 2009; 23(5): 354–360.

30. Nothofer W, Thonke N, Neugebauer R. Die Therapie instabiler Sakrumfrakturen bei Beckenringbrüchen mit dorsaler Sakrumdistanzosteosynthese. Unfallchirurg 2004; 107: 118–128.

31. Bőhme J, Steinke H, Huelse R, et al. Complex Ligament Instabilities after „Open Book“ – Fractures of the Pelvic Ring – Finite Element Computer Simulation and Crack Simulation. Z Orthop Unfall 2011; 149(1): 83–89.

32. Pavelka T, Džupa V, Ryšavý M, et al. Poranění pánevního kruhu. Acta Chir Orthop Traumatol Čech 2006; 73: 405–413.

33. Džupa V, Chmelová J, Pavelka T, et al. Multicentrická studie pacientů s poraněním pánve: základní analýza souboru. Acta Chir Orthop Traumatol Čech 2009; 76(5): 404–409.

Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management fenix.admin.empty
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account