Skip to main content
SpringerLink
Log in

Considerazioni e attuali indicazioni della fissazione esterna nei traumi della pelvi

Discussion and current indications of external fixation in pelvic trauma

  • Articolo Originale
  • Published:
Aggiornamenti CIO

Riassunto

Il trattamento delle fratture di bacino si è evoluto negli ultimi anni da un approccio prevalentemente conservativo a un uso sempre crescente della fissazione. La fissazione esterna nelle fratture di bacino si pone obiettivi differenti in relazione alla presenza contemporanea di altre lesioni che nel complesso possono determinare un quadro di instabilità emodinamica cruciale per la sopravvivenza del paziente. In assenza di problematiche rianimatorie, le fratture di tipo B secondo Tile sono una indicazione chirurgica riconosciuta alla fissazione esterna e l’utilizzo associato di tecniche percutanee di trattamento dell’anello posteriore permette di estendersi alle fratture di tipo C. Il basso “costo biologico” per il paziente della fissazione esterna e la relativa facilità di applicazione, dopo una necessaria curva di apprendimento, sono sicuramente due dei fattori più vantaggiosi di questa metodica rispetto alle tecniche di fissazione interna. Gli Autori presentano una revisione dell’utilizzo della fissazione esterna nelle fratture di bacino e un caso clinico di particolare interesse.

Abstract

Over the past decades the treatment of pelvis fractures has developed from a largely conservative approach to an increasing use of both internal and external fixation. External fixation in fractures of the pelvis focuses on different targets according to the simultaneous presence of other injuries that may lead to hemodynamic instability and threaten the patient’s survival. Without life-saving problems, a shared surgical indication for external fixation is represented by fractures of type B according to Tile, and using a combined percutaneous technique it can be extended to the rear of the ring fracture type C. The low “biological cost” of external fixation and its relatively easy application, after a necessary learning curve, are certainly two of the most advantageous features of this method compared to internal fixation techniques. The Authors present a review of the use of external fixation in fractures of the pelvis and an interesting clinical case.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Bibliografia

  1. Hoffmann R (1938) Rotules à os pour la reduction dirigée non sanglante de fractures (osteotaxis). Helv Med Acta 5:844

    Google Scholar 

  2. Vidal J (1968) Notre experience du fixature externe d’Hoffman a propos de 46 observations. Les indications de son emploi. Montpellier Chir 14:451

    Google Scholar 

  3. Mears DC (ed) (1983) External skeletal fixation. Williams & Wilkins, Baltimore

    Google Scholar 

  4. Slatis P, Karaharju EO (1975) External fixation of the pelvic girdle with a trapezoid compression frame. Injury 7:53–56

    Article  PubMed  CAS  Google Scholar 

  5. Mears DC, Fu FH (1980) Modern concepts of external fixation of the pelvis. Clin Orthop Relat Res 151:65–72

    PubMed  Google Scholar 

  6. McBroom R, Tile M (1982) Disruption of the pelvic ring. Orthop Trans 6:493

    Google Scholar 

  7. Simonian PT, Routt ML Jr, Harrington RM, Tencer AF (1995) Anterior versus posterior provisional fixation in the unstable pelvis. A biomechanical comparison. Clin Orthop Relat Res 310:245–251

    Google Scholar 

  8. Buckle R, Browner BD, Morandi M (1994) Emergency reduction for pelvic ring disruptions and control of associated haemorrhage using the pelvic stabilizer. Tech Orthop 9:258–266

    Article  Google Scholar 

  9. Ghanayem AJ, Stover MD, Goldstein JA et al (1995) Emergent treatment of pelvic fractures. Comparison of methods for stabilization. Clin Orthop Relat Res 318:75–80

    PubMed  Google Scholar 

  10. Tang P, Meredick R, Prayson MJ (2002) External fixation of the pelvis. Tech Orthop 17:228–238

    Article  Google Scholar 

  11. Failinger MS, McGanity PL (1992) Unstable fractures of the pelvic ring. J Bone Joint Surg 74:781–791

    PubMed  CAS  Google Scholar 

  12. Gruen GS, Leit ME, Gruen RJ, Peitzman AB (1994) The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures. J Trauma 36:706–711

    Article  PubMed  CAS  Google Scholar 

  13. Dahners LE, Jacobs RR, Jayaraman G, Cepulo AJ (1984) A study of external fixation systems for unstable pelvic fractures. J Trauma 24: 876–881

    Article  PubMed  CAS  Google Scholar 

  14. Gylling SF, Ward RW, Holcroft JW et al (1985) Immediate external fixation of unstable pelvic fractures. Am J Surg 150:721–724

    Article  PubMed  CAS  Google Scholar 

  15. Simonian PT, Routt ML Jr (1997) Biomechanics of pelvic fixation. Orthop Clin North Am 28:351–367

    Article  PubMed  CAS  Google Scholar 

  16. Vrahus MS, Wilson SC, Cummings PD, Paul EM (1998) Comparison of fixation methods for preventing pelvic ring expansion. Orthopedics 21:285–289

    Google Scholar 

  17. Yang AP, Iannacone WM (1997) External fixation for pelvic ring disruptions. Orthop Clin North Am 28:331–344

    Article  PubMed  CAS  Google Scholar 

  18. Burgess AR (1992) Fractures of the pelvis, part I: the pelvic ring. In: Rockwood CA, Green DP, Bucholz RW (eds) Fractures in adults. JP Lippincott, Philadelphia, pp 1399–1442

    Google Scholar 

  19. van Gulik TM, Raaymakers EL, Broekhuizen AH, Karthaus AJ (1987) Complications and late therapeutic results of conservatively managed, unstable pelvic ring disruptions. Neth J Surg 39:175–178

    PubMed  Google Scholar 

  20. Mason WT, Khan SN, James CL et al (2005) Complications of temporary and definitive external fixation of pelvic ring injuries. Injury 36:599–604

    Article  PubMed  CAS  Google Scholar 

  21. Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg 70:1–12

    CAS  Google Scholar 

  22. Kellam JF (1989) The role of external fixation in pelvic disruptions. Clin Orthop Relat Res 241:66–82

    PubMed  Google Scholar 

  23. Seligson D, Pope M (eds) (1982) Concepts in external fixation. Grune & Stratton, New York

    Google Scholar 

  24. Pohlemann T, Bosch U, Gansslen A, Tscherne H (1994) The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res 305:69–80

    Article  PubMed  Google Scholar 

  25. Trafton PG (1993) Fixation of the pubic symphysis. Operative Techniques in Orthopaedics 3:13–18

    Article  Google Scholar 

  26. Vécsei V, Negrin LL, Hajdu S (2010) Today’s role of external fixation in unstable and complex pelvic fractures. Eur J Trauma Emerg Surg 36:100–106

    Article  Google Scholar 

  27. Sims SH, Bosse M, Kellam J (1994) Indications for stabilization of major pelvic disruptions. Tech Orthop 9:275–282

    Article  Google Scholar 

  28. Burgess AR, Eastridge BJ, Young JW et al (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30:848–856

    Article  PubMed  CAS  Google Scholar 

  29. Reimer BL, Butterfield SL, Diamond DL et al (1993) Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma 35:671–675

    Article  Google Scholar 

  30. Mucha P Jr (1991) Pelvic fractures. In: Moore EE, Mattox KL, Feliciano DV (eds) Trauma. Appleton and Lange, Norwalk, CT, pp 553–569

    Google Scholar 

  31. Mucha P Jr, Farnell MB (1984) Analysis of pelvic fracture management. J Trauma 24:379–386

    Article  PubMed  Google Scholar 

  32. Vrahas M (1994) Fixation of pubic symphysis diastasis and pubic rami fractures. Tech Orthop 9:283–289

    Article  Google Scholar 

  33. Wolinsky PR (1997) Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin North Am 28:321–329

    Article  PubMed  CAS  Google Scholar 

  34. Hanson PB, Milne JC, Chapman MW (1991) Open fractures of the pelvis. Review of 43 cases. J Bone Joint Surg 73:325–329

    CAS  Google Scholar 

  35. Burgess AR (1995) External fixation. In: Tile M (ed) Fracture of the pelvis and acetabulum. Williams & Wilkins, Baltimore, pp 135–499

    Google Scholar 

  36. Cryer HM, Millier FB, Evers BM et al (1988) Pelvic fracture classification correlation with hemorrhage. J Trauma 28:973–980

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. AUSL1 di Massa e Carrara — Regione Toscana, UO di Ortopedia e Traumatologia, Fivizzano, Italy

    B. Pavolini, L. Marzona & M. Aliani

Authors
  1. B. Pavolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Marzona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Aliani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Pavolini.

About this article

Cite this article

Pavolini, B., Marzona, L. & Aliani, M. Considerazioni e attuali indicazioni della fissazione esterna nei traumi della pelvi. Aggiornamenti 18, 85–92 (2012). https://doi.org/10.1007/s10351-012-0014-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10351-012-0014-0

Parole chiave

Key Words

Search

Navigation