Emergency pelvic stabilization in patients with pelvic posttraumatic instability

Poenaru, Dan V.; Popescu, Mircea Ioachim; Anglitoiu, Bogdan; Popa, Iulian; Andrei, Diana; Bîrsăşteanu, Florin

doi:10.1007/s00264-015-2727-5

Cited by 23 publications

(13 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The instability of the pelvic ring is caused by fractures of the bilateral superior and inferior pubic rami and ischial rami. The mortality rate is 8.5–19% in polytrauma patients with pelvic fractures [6]. Shockingly, the mortality rate increases to 18–25% in patients with hemodynamic instability [6].…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate is 8.5–19% in polytrauma patients with pelvic fractures [6]. Shockingly, the mortality rate increases to 18–25% in patients with hemodynamic instability [6]. Moreover, the risk of internal organ injuries increases when there are migrating fracture fragments [5].…”

Section: Discussionmentioning

confidence: 99%

“…External fixation remains the gold standard in the emergent treatment of anterior pelvic fractures [6], especially in patients with hemorrhagic shock and/or significant soft tissue damage. However, there are disadvantages to using an external fixator, including pin tract infection, loosening, skin impingement by pins, osteomyelitis, inconvenience regarding wound care and mobility, and negative effects on a patient’s quality of life [16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the energy level of the trauma, the mortality rate is between 18 and 25% in patients with hemodynamic instability [6]. Therefore, pathophysiological and hemodynamic stabilization should be considered carefully before surgical intervention is undertaken.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Biomechanical characteristics of fixation methods for floating pubic symphysis

Song

Zhou

2017

J Orthop Surg Res

View full text Add to dashboard Cite

BackgroundFloating pubic symphysis (FPS) is a relatively rare injury caused by high-energy mechanisms. There are several fixation methods used to treat FPS, including external fixation, subcutaneous fixation, internal fixation, and percutaneous cannulated screw fixation. To choose the appropriate fixation, it is necessary to study the biomechanical performance of these different methods. The goal of this study was to compare the biomechanical characteristics of six methods by finite element analysis.MethodsA three-dimensional finite element model of FPS was simulated. Six methods were used in the FPS model, including external fixation (Ext), subcutaneous rod fixation (Sub-rod), subcutaneous plate fixation (Sub-plate), superior pectineal plate fixation (Int-sup), infrapectineal plate fixation (Int-ifa), and cannulated screw fixation (Int-scr). Compressive and rotational loads were then applied in all models. Biomechanical characteristics that were recorded and analyzed included construct stiffness, micromotion of the fracture gaps, von Mises stress, and stress distribution.ResultsThe construct stiffness of the anterior pelvic ring was decreased dramatically when FPS occurred. Compressive stiffness was restored by the three internal fixation and Sub-rod methods. Unfortunately, rotational stiffness was not restored satisfactorily by the six methods. For micromotion of the fracture gaps, the displacement was reduced significantly by the Int-sup and Int-ifa methods under compression. The internal fixation methods and Sub-plate method performed well under rotation. The maximum von Mises stress of the implants was not large. For the plate-screw system, the maximum von Mises stress occurred over the region of the fracture and plate-screw joints. The maximum von Mises stress appeared on the rod-screw and screw-bone interfaces for the rod-screw system.ConclusionsThe present study showed the biomechanical advantages of internal fixation methods for FPS from a finite element view. Superior stabilization of the anterior pelvic ring and fracture gaps was obtained by internal fixation. Subcutaneous fixation had satisfactory outcomes as well. Sub-rod fixation offered good anti-compression, while the Sub-plate fixation provided favorable anti-rotational capacity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Biomechanical characteristics of fixation methods for floating pubic symphysis

Song

Zhou

2017

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…Pelvic ring disruptions in hemodynamically unstable patients should be temporarily stabilized to prevent further hemorrhage and to support measures of hemorrhage control, including angiography and pelvic packing [28, 46, 58, 96, 97]. The rationale for acute external pelvic fixation consists of (1) reducing the intrapelvic volume in “open book” equivalent injuries to decrease the retroperitoneal bleeding space, and (2) to provide a stable counter-pressure to the “packed” lap sponges for effective pelvic packing.…”

Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

View full text Add to dashboard Cite

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

show abstract