External Fixation of the Pelvis in Damage Control Orthopedics



Damage control orthopedics for pelvic fractures involves early identification of the potentially lethal injury which can cause exsanguination [1], and prompt decision making to determine which fracture patterns require pelvic external fixation.


Iliac Crest External Fixation Pelvic Fracture Pelvic Ring Sacral Fracture 
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  1. 1.
    Van Vugt AB, Van Kampen A, Van Vugt AB, Van Kampen A. An unstable pelvic ring. J Bone Joint Surg Br. 2006;88-B(4):427–33.CrossRefGoogle Scholar
  2. 2.
    Mears DC. Clinical techniques in the pelvis. In: Mears DC, editor. External skeletal fixation. Baltimore: Williams and Wilkins; 1983. p. 342.Google Scholar
  3. 3.
    Slatis P, Karaharju EO. External fixation of the pelvic girdle with a trapezoid compression frame. Injury. 1975;7(1):53–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Slatis P, Karaharju EO. External fixation of unstable pelvic fractures: experiences in 22 patients treated with a trapezoid compression frame. Clin Orthop Relat Res. 1980;151:73–80.PubMedGoogle Scholar
  5. 5.
    Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;5:671–7.CrossRefGoogle Scholar
  6. 6.
    Ganz R, Krushell RJ, Jacob RP, et al. The antishock pelvic clamp. Clin Orthop Relat Res. 1991;267:71–8.PubMedGoogle Scholar
  7. 7.
    Heini PF, Witt J, Ganz R. The pelvic C-clamp for the emergency treatment of unstable pelvic ring injuries. A report on clinical experience of 30 cases. Injury. 1996;27 Suppl 1:S-A38–45.Google Scholar
  8. 8.
    Solomon LB, Pohl AP, Chehade MJ, et al. Surgical anatomy for pelvic external fixation. Clin Anat. 2008;21(7):674–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Vrahas MS, Wilson SC, Cummings PD, et al. Comparison of fixation methods for preventing pelvic ring expansion. Orthopedics. 1998;21(3):285–9.PubMedGoogle Scholar
  10. 10.
    Rommens M, Hessmann ML. External fixation for the injured pelvic ring. In: Tile M, editor. Fractures of the pelvis and acetabulum. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar
  11. 11.
    Haidukewych GJ, Kumar S, Prpa P. Placement of half-pins for supra-acetabular external fixation: an anatomic study. Clin Orthop Relat Res. 2003;411:269–73.PubMedCrossRefGoogle Scholar
  12. 12.
    Deridder VA, DeLange S, Popta JV. Anatomic variations of the lateral femoral cutaneous nerve and the consequence for surgery. J Orthop Trauma. 1999;13:207–11.CrossRefGoogle Scholar
  13. 13.
    Hospodar PP, Ashman ES, Traub JA. Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinguinal surgical dissection. J Orthop Trauma. 1999;13:17–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Pohlemann T, Braune C, Gansslen A, et al. Pelvic emergency clamps: anatomic landmarks for a safe primary application. J Orthop Trauma. 2004;18(2):102–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Grimm MR, Vrahas MS, Thomas KA. Pressure-volume characteristics of the intact and disrupted pelvic peritoneum. J Trauma. 1998;44(3):454–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Bottlang M, Simpson T, Sigg J, et al. Noninvasive reduction of open-book pelvic fractures by circumferential compression. J Orthop Trauma. 2002;6(6):367–73.CrossRefGoogle Scholar
  17. 17.
    Simonian PT, Routt Jr ML, Harrington RM, et al. Anterior versus posterior provisional fixation in the unstable pelvis. A biomechanical comparison. Clin Orthop Relat Res. 1995;310:245–51.PubMedGoogle Scholar
  18. 18.
    Gardner MJ, Kendoff D, Ostermeier S, et al. Sacroiliac joint compression using an anterior pelvic compressor: a mechanical study in synthetic bone. J Orthop Trauma. 2007;21(7):435–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Ponson KJ, van Dijke GA Hoek, Joosse P, et al. Improvement of external fixator performance in type C pelvic ring injuries by plating of the pubic symphysis: an experimental study on 12 external fixators. J Trauma. 2002;53(5):907–12; discussion 912–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Archdeacon MT, Arebi S, Le TT, et al. Orthogonal pin construct versus parallel uniplanar pin constructs for pelvic external fixation: a biomechanical assessment of stiffness and strength. J Orthop Trauma. 2009;23(2):100–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Garcia JM, Doblare M, Serai B, Serai F, Palanca D, Gracia L. Three-dimensional finite element analysis of several internal and external pelvic fixations. J Biomech Eng. 2000;122(5):516–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Rieger H, Brug E. Fractures of the pelvis in children. Clin Orthop Relat Res. 1997;336:226–39.PubMedCrossRefGoogle Scholar
  23. 23.
    Noordeen MHH, Taylor BA, Briggs TWR, et al. Pin placement in pelvic external fixation. Injury. 1993;24:581–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Bone L. Emergency treatment of the injured patient. In: Browner B, Jupiter J, Levine A, Trafton P, editors. Skeletal trauma. Philadelphia: Saunders; 1992.Google Scholar
  25. 25.
    Huittinen V. Lumbosacral nerve injury in fracture of the pelvis. Acta Chir Scand. 1972;429(Suppl):3–43.Google Scholar
  26. 26.
    Cook RE, Keating JF, Gillespie I. The role of angiography in the management of hemorrhage from major fractures of the pelvis. J Bone Joint Surg. 2002;84(2):178–82.CrossRefGoogle Scholar
  27. 27.
    Tscherne H, Pohlemann T, Gansslen A, et al. Crush injuries of the pelvis. Eur J Surg. 2000;166(4):276–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Pohlemann T, Paul C, Gansslen A, et al. Die traumatische hemipelvectomie. Erfahrungen aus 11 Fallen. Unfallchirurg. 1996;99:304–12.PubMedCrossRefGoogle Scholar
  29. 29.
    Bellabarba C, Ricci WM, Bolhofner BR. Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma. 2000;14(7):475–82.PubMedCrossRefGoogle Scholar
  30. 30.
    Bellabarba C, Ricci WM, Bolhofner BR. Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma. 2006;20(1 Suppl):S7–14.PubMedGoogle Scholar
  31. 31.
    Kellam JF. The role of external fixation in pelvic disruptions. Clin Orthop Relat Res. 1989;241:66–82.PubMedGoogle Scholar
  32. 32.
    Pennig D, Gladbach B, Majchrowski W. Disruption of the pelvic ring during spontaneous child birth. J Bone Joint Surg Br. 1997;79(3):438–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Hoshino Y, Doita ML, Yoshikawa M, et al. Unstable pelvic insufficiency fracture in a patient with rheumatoid arthritis. Rheumatol Int. 2004;24(1):46–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction. J Orthop Trauma. 2007;21(9):647–56.PubMedCrossRefGoogle Scholar
  35. 35.
    Burgess AR, Eastridge BJ, Young JWR, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;3Q:848–56.CrossRefGoogle Scholar
  36. 36.
    Dalai SA, Burgess AR, Siegel JH, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements and outcome. J Trauma. 1989;29:981–1002.CrossRefGoogle Scholar
  37. 37.
    Young JWR, Burgess AR, Brumback RJ, et al. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160:445–51.PubMedGoogle Scholar
  38. 38.
    Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70(B):1–12.Google Scholar
  39. 39.
    Duxbury MS, Rossiter ND, Lambert AW. Cable ties for pelvic stabilization. Ann R Coll Surg Engl. 2003;85:130.PubMedCrossRefGoogle Scholar
  40. 40.
    Simpson T, Krieg J, Heuer F, et al. Stabilization of pelvic ring disruptions with a circumferential sheet. J Trauma. 2002;52(1):158–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Vermeulen B, Peter R, Hoffmeyer P, et al. Prehospital stabilization of pelvic dislocations: a new strap belt to provide temporary hemodynamic stabilization. Swiss Surg. 1999;5:43–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Schutz M, Stockle U, Hoffmann R, et al. Clinical experience with two types of pelvic C-clamps for unstable pelvic ring injuries. Injury. 1996;27 Suppl 1:SA46–50.Google Scholar
  43. 43.
    Buckle R, Browner B, Morande M. Emergency reduction for pelvic ring disruptions and control of associated hemorrhage using the pelvic stabilizer. Tech Orthop. 1995;9:258–66.CrossRefGoogle Scholar
  44. 44.
    Reynolds JH, Attum B, Acland RD, et al. Anterior versus posterior pin placement of pelvic C-clamp in relationship to anatomical structures: a cadaver study. Injury. 2008;39(8):865–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Archdeacon MT, Hiratzka MS. The trochanteric c-clamp for provisional pelvic stability. J Orthop Trauma. 2006;20(1):47–51.PubMedCrossRefGoogle Scholar
  46. 46.
    Holt GE, Mencio GA. Pelvic C-clamp in a pediatric patient. J Orthop Trauma. 2003;17(7):525–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Pohlemann T, Gansslen A, Bosch U, et al. The technique of packing for control of hemorrhage in complex pelvic fractures. Tech Orthop. 1994;9:267–70.CrossRefGoogle Scholar
  48. 48.
    Yang A, Lannacone WM. External fixation for pelvic ring disruptions. Orthop Clin N Am. 1997;28(3):331–44.CrossRefGoogle Scholar
  49. 49.
    Zinghi GF et al. Fractures of the pelvis and acetabulum. Stuttgard: Georg Thieme Verlag; 2004. p. 69–70.Google Scholar
  50. 50.
    Kim WT, Hearn TC, Saleem O, et al. Effect of pin location on stability of pelvic external fixation. Clin Orthop Relat Res. 1999;61:237–44.CrossRefGoogle Scholar
  51. 51.
    Gardner MJ, Nork SE. Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 2007;21(4):269–73.PubMedCrossRefGoogle Scholar
  52. 52.
    Solomon LB, Pohl AP, Sukthankar A, et al. The subcristal pelvic external fixator: technique, results, and rationale. J Orthop Trauma. 2009;23(5):365–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Ponsen KJ, Joosse P, Van Dijke GA, et al. External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins. Acta Orthop. 2007;78(5):648–53.PubMedCrossRefGoogle Scholar
  54. 54.
    Lefaivre KA, Starr AJ, Barker BP, et al. Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame. J Bone Joint Surg Br. 2009;91(9):1201–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36(5):599–604.PubMedCrossRefGoogle Scholar
  56. 56.
    Stewart MC, Little RE, Highland TR. Osteomyelitis of the ilium secondary to external pelvic fixation. J Trauma. 1986;26(3):284–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Hoffmann PR. Du danger des fixators externes et des moyens de le pallier. Acta Chir Belg. 1957;6:585–602.Google Scholar
  58. 58.
    Mahan J, Seligson D, Henry SL, et al. Factors in pin tract infections. Orthopedics. 1991;14:305–8.PubMedGoogle Scholar
  59. 59.
    Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990;250:81–104.PubMedGoogle Scholar
  60. 60.
    Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17(7):503–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Magyar G, Toksvig-Larsen S, Moroni A. Hydroxyapatite coating of threaded pins enhances fixation. [Clinical Trial. Journal Article. Randomized Controlled Trial]. J Bone Joint Surg Br. 1997;79(3):487–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Moroni A, Aspenberg P, Toksvig-Larsen S, et al. Enhanced fixation with hydroxyapatite coated pins. [Clinical Trial. Journal Article. Randomized Controlled Trial]. Clin Orthop Relat Res. 1998;346:171–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Dickson KF, Matta JM. Skeletal deformity after anterior external fixation of the pelvis. J Orthop Trauma. 2009;23(5):327–32.PubMedCrossRefGoogle Scholar
  64. 64.
    Hupel TM, McKee MD, Waddell JP, et al. Primary external fixation of rotationally unstable pelvic fractures in obese patients. J Trauma. 1998;45(1):11–5.CrossRefGoogle Scholar
  65. 65.
    Bartlett CS, Ali A, Helfet DL. Bladder incarceration in a traumatic symphysis pubis diastasis treated with external fixation: a case report and review of the literature. J Orthop Trauma. 1998;12(1):64–7.PubMedCrossRefGoogle Scholar
  66. 66.
    Chitale SV, Almeida A, Hadfield JIH. Urological complication of pelvic fracture treated by an external fixator. Br J Urol. 1997;80(4):681–2.PubMedCrossRefGoogle Scholar
  67. 67.
    Cass AS, Behrens F, Comfort T, et al. Bladder problems in pelvic injuries treated with external fixator and direct urethral drainage. J Trauma. 1983;23(1):50–3.PubMedCrossRefGoogle Scholar
  68. 68.
    Geracci JJ, Morey AF. Bladder entrapment after external fixation of traumatic pubic diastases: importance of follow-up computed tomography in establishing prompt diagnosis. Mil Med. 2000;65(6):492–3.Google Scholar
  69. 69.
    Tillman RM, Kenny NW. Small bowel obstruction as a complication of the use of an external fixator in a pelvic fracture. Injury. 1991;22(1):71–2.PubMedCrossRefGoogle Scholar
  70. 70.
    Checketts RG, MacEachern AG, Otterburn M. Pin tract infection and the principles of pin site care. In: De Bastiani G, Apley AG, Goldberg A, editors. Orthofix external fixation in trauma and orthopaedics. London: Springer; 2000. p. 97–100.CrossRefGoogle Scholar
  71. 71.
    Checketts RG, Otterbum M, MacEachem AG. Pin tract infection: definition, incidence and prevention. Int J Orthop Trauma. 1993;3:16–9.Google Scholar
  72. 72.
    Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996;329:160–79.PubMedCrossRefGoogle Scholar
  73. 73.
    Pape HC, van Griensven M, Rice J, et al. Major secondary surgery in blunt trauma patients and peri-operative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma. 2001;50(6):989–1000.PubMedCrossRefGoogle Scholar

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© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity Hospital LouisvilleLouisvilleUSA

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