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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