Rebecca G Stewart1, Niels Hammer2,3,4, David C Kieser1. 1. Department of Orthopaedic Surgery and MSM, University of Otago, Christchurch, New Zealand. 2. Department of Anatomy, University of Otago, Dunedin, New Zealand. 3. Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany. 4. Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany.
Abstract
BACKGROUND: Unstable pelvic fractures are typically caused by high-impact trauma. Early stabilization is required to prevent further neurological or visceral injury, haemorrhage, reduce pain, infection and long-term deformity and disability. The aim was to review the optimal external fixation techniques and management for unstable pelvic fractures. METHODS: A total of 28 studies were identified from the initial database search. Seventeen studies met our inclusion criteria - eight prospective cohorts, four retrospective cohorts and five in vitro studies. This equated to 539 patients and 38 cadaveric (in vitro) models. RESULTS: Type B and double vertical fractures have less re-displacement (43.7% and 68.2% <5 mm, respectively) than Type C fractures (55.7% >15 mm) regardless of pin placement. Greater than 50% experience a complication with the most common being pin site infection (36%) and a trend towards increased infection with increasing pins was seen. Most can be managed with antibiotics alone (93%). A minimum time of 6-8 weeks in frame was required for definitive management of all fractures. CONCLUSION: This review supports the use of supra-acetabular pins over iliac crest pins to decrease re-displacement, the least number of pins for the shortest amount of time and the largest size pin where possible. Type B fractures will generally have a better outcome than Type C fractures. Definitive management in a frame should be at least 8 weeks. Further studies directly comparing iliac crest and supra-acetabular pin placement are recommended.
BACKGROUND: Unstable pelvic fractures are typically caused by high-impact trauma. Early stabilization is required to prevent further neurological or visceral injury, haemorrhage, reduce pain, infection and long-term deformity and disability. The aim was to review the optimal external fixation techniques and management for unstable pelvic fractures. METHODS: A total of 28 studies were identified from the initial database search. Seventeen studies met our inclusion criteria - eight prospective cohorts, four retrospective cohorts and five in vitro studies. This equated to 539 patients and 38 cadaveric (in vitro) models. RESULTS: Type B and double vertical fractures have less re-displacement (43.7% and 68.2% <5 mm, respectively) than Type C fractures (55.7% >15 mm) regardless of pin placement. Greater than 50% experience a complication with the most common being pin site infection (36%) and a trend towards increased infection with increasing pins was seen. Most can be managed with antibiotics alone (93%). A minimum time of 6-8 weeks in frame was required for definitive management of all fractures. CONCLUSION: This review supports the use of supra-acetabular pins over iliac crest pins to decrease re-displacement, the least number of pins for the shortest amount of time and the largest size pin where possible. Type B fractures will generally have a better outcome than Type C fractures. Definitive management in a frame should be at least 8 weeks. Further studies directly comparing iliac crest and supra-acetabular pin placement are recommended.
Authors: Xiangquan Chu; Katya E Strage; Michael Hadeed; Joshua A Parry; August Funk; Clay Burlew; Cyril Mauffrey Journal: Int Orthop Date: 2021-03-28 Impact factor: 3.075