Supraacetabular External Fixation for Pelvic Ring Fractures

Abstract

Objective:

Closed reduction and maintenance of pelvic ring injuries by external stabilization.

Indications:

Emergency management of unstable type B and type C pelvic ring fractures.

Definitive treatment of type B injuries.

Definitive treatment of the anterior pelvic ring in type C injuries with transpubic instability after posterior internal stabilization.

Adjunct stabilization of internal fixation.

Stabilization of pelvic ring fractures in children.

Contraindications:

Poor general condition.

Local soft-tissue damage.

Local infection.

Surgical Technique:

Bilateral percutaneous insertion of Schanz screws into the supraacetabular area of iliac bone. Closed reduction and stabilization of the pelvic ring by compression and application of a connecting rod under image intensification.

Postoperative Management:

Depending on the patient’s condition and the degree of pelvic instability, a change to an open procedure may become necessary.

Mobilization of the patient with partial weight bearing (one fifth of body weight) on the side of the injured posterior pelvic ring using forearm crutches, irrespective of the degree of stability of the pelvis.

Results:

Retrospective analysis of 64 supraacetabular external fixator applications to stabilize the anterior pelvic ring in 20 type B and 44 type C injuries.

Iatrogenic lesions of the lateral femoral cutaneous nerve: 4.5%; all sensory disturbances completely reversed within 1 year. No pin site infection. In two patients (3%) primary perforation of the Schanz screw into the small pelvis not necessitating any treatment. No secondary displacements of the anterior or posterior pelvic ring in type B injuries nor for type C injuries, sacral fractures associated with fractures of the pubic ramus. One pseudarthrosis of the pubic and ischial rami requiring surgical treatment.