pelvic fractures & fixation devices j.e.tannebaum pgy4 general surgery
TRANSCRIPT
PELVIC FRACTURES & FIXATION DEVICES
J.E.Tannebaum PGY4 General Surgery
Pelvic Fractures
Lateral Compression Types I-III Horizontally oriented
pubic fractures force is from side
Anteroposterior Compression Types I-III Sagittal disruptive force
(MVAs) Anterior pelvic disruption
Vertical Shear
Lateral Compression
Type I Sacral compression fx on side of impact
Type II Iliac wing fracture on side of impact
Type III LC type I or II fracture + contralateral Anteroposterior
Compression Fracture
Horizontally oriented pubic fractures (force is from side)
Anteroposterior Compression
Type I pubic rami or ligament disruption Slight widening of symphysis
Type II Iliac wings rotated externally “hinging” at SI joint posterior aspect “Open Book”
Type III Complete disruption of sacroiliac ligaments unstable
Vertical Shear
Fall from heights Anterior: both pubic ramis fractured Posterior: SI complex or sacral
fracture
Pelvic Stabilization
Goal: reduce pelvic volume to decrease hemorrhage (earlier tamponade)
External Pelvic Fixation (EPF) Standard Invasive
Temporary stabilization Quickly applied (5-60min) Lower transfusion volumes at 24h & 48h
C-clamp T-pod
Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 71, Number 6, December 2011 EAST Pelvic Fracture Guidelines
Pelvic Stabilization
“because of their ease of use and fast application, TPBs have largely replaced the pelvic C-Clamp and EPF for early mechanical stability in pelvic fracture”
Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 71, Number 6, December 2011 EAST Pelvic Fracture Guidelines
References
Wheeless’ Textbook of Orthopedics Accessed online 11/27/12 http://www.wheelessonline.com/ortho/
classification_1 Young JW, Resnik CS. Fracture of the pelvis:
current concepts of classification. AJR, Dec 1990, 155:1169-1175.
Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 71, Number 6, December 2011 EAST Pelvic Fracture Guidelines