Xiangquan Chu1, Katya E Strage1, Michael Hadeed1, Joshua A Parry1, August Funk1, Clay Burlew1, Cyril Mauffrey2. 1. Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA. 2. Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA. cyril.mauffrey@dhha.org.
Abstract
PURPOSE: External fixation has been widely implemented as a resuscitation strategy in combination with pelvic packing for high energy, hemodynamically unstable, pelvic ring injuries. The primary aim of this study is to compare urgent iliac crest (IC) versus supraacetabular (SA) external fixation in the setting of haemodynamic instability. METHODS: This is a retrospective review of a prospectively gathered registry at an urban level one trauma centre comparing placement of pelvic external fixator by SA or IC technique. Outcomes assessed were accuracy of pin placement, duration of procedure, and the effect on true pelvic circumference depending on type of fracture by Young and Burgess Classification system. RESULTS: Ninety-three haemodynamically unstable patients with a pelvic fracture included. Pin malpositioning was more common with IC than SA groups (proportional difference, - 40%; 95% CI, - 57 to - 20%; p < 0.0001). For APC injuries, there was a larger median reduction in pelvic circumference in the SA group than the IC group (median difference [MD], - 12.85 cm; 95% CI, - 27 to 0.1; p = 0.0485). In LC injuries, the SA group had an overall increase in pelvic circumference compared to an overall decrease in IC group (MD, 6.5 cm; 95% CI, 1.5 to 16.8; p = 0.0221). There was no difference in the operating room (OR) time (mean difference, - 5.4 min; 95% CI, - 32 to 22; p = 0.68). CONCLUSIONS: In this clinical setting, we recommend placement of SA external fixator (versus IC) with similar operative times, fewer pin malpositions, and improved stabilization of pelvic circumference in APC and LC injuries.
PURPOSE: External fixation has been widely implemented as a resuscitation strategy in combination with pelvic packing for high energy, hemodynamically unstable, pelvic ring injuries. The primary aim of this study is to compare urgent iliac crest (IC) versus supraacetabular (SA) external fixation in the setting of haemodynamic instability. METHODS: This is a retrospective review of a prospectively gathered registry at an urban level one trauma centre comparing placement of pelvic external fixator by SA or IC technique. Outcomes assessed were accuracy of pin placement, duration of procedure, and the effect on true pelvic circumference depending on type of fracture by Young and Burgess Classification system. RESULTS: Ninety-three haemodynamically unstable patients with a pelvic fracture included. Pin malpositioning was more common with IC than SA groups (proportional difference, - 40%; 95% CI, - 57 to - 20%; p < 0.0001). For APC injuries, there was a larger median reduction in pelvic circumference in the SA group than the IC group (median difference [MD], - 12.85 cm; 95% CI, - 27 to 0.1; p = 0.0485). In LC injuries, the SA group had an overall increase in pelvic circumference compared to an overall decrease in IC group (MD, 6.5 cm; 95% CI, 1.5 to 16.8; p = 0.0221). There was no difference in the operating room (OR) time (mean difference, - 5.4 min; 95% CI, - 32 to 22; p = 0.68). CONCLUSIONS: In this clinical setting, we recommend placement of SA external fixator (versus IC) with similar operative times, fewer pin malpositions, and improved stabilization of pelvic circumference in APC and LC injuries.
Authors: Gilberto José Cação Pereira; Erick Ribeiro Damasceno; Daniel Innocenti Dinhane; Francisco Marques Bueno; Jaqueline Bartelega Rodrigues Leite; Bruno da Costa Ancheschi Journal: Rev Bras Ortop Date: 2017-05-19
Authors: Federico Coccolini; Philip F Stahel; Giulia Montori; Walter Biffl; Tal M Horer; Fausto Catena; Yoram Kluger; Ernest E Moore; Andrew B Peitzman; Rao Ivatury; Raul Coimbra; Gustavo Pereira Fraga; Bruno Pereira; Sandro Rizoli; Andrew Kirkpatrick; Ari Leppaniemi; Roberto Manfredi; Stefano Magnone; Osvaldo Chiara; Leonardo Solaini; Marco Ceresoli; Niccolò Allievi; Catherine Arvieux; George Velmahos; Zsolt Balogh; Noel Naidoo; Dieter Weber; Fikri Abu-Zidan; Massimo Sartelli; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-01-18 Impact factor: 5.469