pelvic ring fractures. treatment with monolateral external fixation. a.pizzoli, l.renzi brivio

8/6/2019 Pelvic Ring Fractures. Treatment with Monolateral External Fixation. A.Pizzoli, L.Renzi Brivio

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Pelvic Ring Fractures. Treatment with Monolateral External Fixation

A.Pizzoli, L.Renzi Brivio

Orthopaedic and Traumatology Department, C. Poma Hospital Mantova (Italy)

Abstract

In the treatment of pelvic ring lesions is mandatory to identify the lesions which need surgical treatment.

Epidemiologic data demonstrated the association of these lesions with an high percentage of organ morbidity andhaemodinamic instability that is generally the primary cause of death.

The mortality rate is strictly correlated to the Type and degree of instability and the degree of open fracture.

For these reasons is important to perform a precise preoperative assessment using the most known classification:

Young-Burgess classification relative to the type and energy of the trauma (J.Trauma 83:848,1990) and

Tile classification related to the degree and plane of instability (JAAOS 4:143,1996).

According to Tile classification we can identify the lesions (partially or totally unstable) which need a surgical

treatment in emergency which is generally carried out using an external fixator or a pelvic clamp system.

In partially unstable lesions (horizontal instability) like open or closed book ex fix can be considered the treatment

of choice in emergency and also a possible alternative to ORIF as definitive treatment. The good tolerance of the

monolateral frame and its versatility allow a surgical approach to pelvic or abdominal organs when necessary and

permits an early rehabilitation program.

The possibility to manipulate the two-hemi pelvis with the fixator facilitates a proper recovery of pelvic morphology

reducing at the same time retroperitoneal bleeding.

In totally unstable lesions (horizontal and vertical instability) external fixation is extremely useful in emergency as

life-saving device but is not powerful enough to guarantee posterior stability. For this reason is possible, after acute

treatment, to associate external fixation to a minimal posterior stabilisation ( screws) as alternative to the standard

open surgical approach.

The authors will present their experience with this kind of treatment strategy using different monolateral frames in

relation to the type of injury and associated lesions.


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EXTERNAL FIXATIONIN PELVIC RING FRACTURES

Dott. A.L.Pizzoli

Orthopaedic and Traumatologic Department

C. Poma Hospital Mantova Italy


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PELVIC RING ANATOMYPELVIC RING ANATOMY

Bone Ligaments


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POLITRAUMA + PELVIC RING

Morbility (60-80%)

Head trauma 70%

Uro-genital lesions 63%

Neurological lesions 24%Vascular lesions 23%

Abdominal lesions 20%

Mortality

Unstable fractures (10-30%) Open (30-50%)


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LIFE SAVING SURGERY


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INSTRUMENTS


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Link Orthofix External fixator


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-- STABLESTABLE

HORIZONTAL Instability.HORIZONTAL Instability.

PELVIC RING Instability

Tile 1990

Type A

Type C

Type B

VERTICAL /MIXED InstabilityVERTICAL /MIXED Instability-- UNSTABLEUNSTABLE


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Type 2: HORIZONTAL INSTABILITY

DEFINITIVE EXTERNAL FIXATION


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FIXATORAPPLICATION


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Open book (APC)


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Horizontally unstable Vertically stable


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Definitive treatmentANTERIOR EX FIX


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CLOSED BOOK (LC)


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Type 3: Vertical instability

Emergency Ex. Fix. + delayed posterior Int. Fix.


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1 d d F


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1 . Anterior Standard Frame

2 A i i l F


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2. Anterior triangular Frame


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3 A t i F t i fi ti


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3. Anterior Frame + posterior fixation


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SACROILIAC JOINT STABILISATION


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E. Letournel: Rev. Chir. Ortop 1981

Traitment chirurgical des trauamtismes du bassin en dehors du fractures du cotyle

1. OPEN (ant o post)

2. PERCUTANEOUS ( fluoroscopy)

3. PERCUTANEOUS (CT scan)


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CT guided fixation of sacral fractures and SI joint disrutions


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CT guided fixation of sacral fractures and SI joint disrutions

Nelson DW, DuweliusPJ: Radiology 180;527-532,1991


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6 mesi


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HORIZONTALLY UNSTABLE LESIONS

EMERGENCY and DEFINITIVE STABILIZATION

VERTICALLY UNSTABLE LESIONS

EMERGENCY STABILIZATION

ASSOCIATED TO INTERNAL FIXATION (5-7 DAYS LATER)

Pelvic ring and External fixation


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Mantova night view


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SCREW PLACEMENT


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SCREW PLACEMENT


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Screws directions


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Immagine HA

coated

Preferred approach


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pp

SCREW INSERTION


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SCREW INSERTION

SCREW INSERTION


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SCREW INSERTION

FIXATOR APPLICATION


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pelvic ring fractures. treatment with monolateral external fixation. a.pizzoli, l.renzi brivio

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