PELVIC FRACTURES:EXTERNAL FIXATION

DR. MOHIT SHARMADR. ANKIT MADHARIA

JUNIOR RESIDENTLATA MANGESHKAR HOSPITAL

Pelvic Ring Injuries

High energy

Morbidity/Mortality

Hemorrhage

Pelvic Ring Injuries

An unstable pelvic injury may allow hemorrhage to collect in the true pelvis as there is no longer a constraint which allows tamponade.

Best estimated by a hemi-elliptical sphere(Stover et al, J Trauma, 2006)

Hemorrhage Control: Methods

• Closed reduction of pelvis at admission.

• External fixation.• Control of haemorrhage.• Pelvic packing.• Angiography.• Control of contamination.• Repair of genitourinary and rectal

injuries.• Debridement of necrotic tissue in

case of open injury.

Circumferential Sheeting

• Supine

• 2 “Wrappers”

• Placement

• Apply

• “Clamper”

• 30 Seconds

1

2

34

Routt et al, JOT, 2002

Pelvic Binders

Commercially available.Placed over the TROCHANTERS and not over the abdomen and chest.

External Fixation• Location

AIIS(low route frame)

ASIS(high route frame)

C-clamp

External Fixation:Considerations

• Pin size

• Number of pins

• Frame design.

• Frame location.

EXTERNAL FIXATOR FRAMES:

ASIS FRAME DESIGNS/HIGH ROUTE FRAMES:

Most commonly used is a simple two pin external fixator design.

SURGICAL LANDMARK AND INCISION:

Technical Details: ASIS frames…

• Fluoroscopy dependent• 3 to 5 cm posterior to the ASIS• Along the gluteus medius pillar• Pin entry at the junction of the lateral

2/3 and medial 1/3 of the iliac crest• Aim: 30 to 45 degrees (from lateral

to medial)

• Towards hip joint, convergent pins.

Pin Orientation: ASIS

Outlet Oblique Image

• Inner Table

• Outer Table

• ASIS

Outlet Oblique Image

• Inner Table

• Outer Table

• ASIS

Technical Details: AIIS frames…

• Fluoroscopy dependent:• Incision 2-3 cm distal to ASIS

directed toward the anticipated final location.

• Gently spreading soft tissues .• Aiming 20-30 degrees

medially.

Pin Orientation: AIIS

Pin Orientations

Anti-shock Clamp (C-clamp)

Better posterior pelvis stabilization

Allows abdominal access

Can be combined with pelvic packing

Anti-shock Clamp (C-clamp)

Anti-shock Clamp (C-clamp)

The insertion points for the pins lie on the crossing point of the femoral shaft axis and on a vertical line starting just caudal to the anterior superior illiac spine.

THANK YOU