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   Young JW, Resnik CS. Fracture of the pelvis: current concepts of classification. AJR, Dec 1990, 155:  Journal of TRAUMA® Injury, Infection, and Critical Care Volume 71, Number 6, December 2011 EAST Pelvic Fracture Guidelines