Severe Pelvic Bleeding: The Role of Primary Internal Fixation

Abstract

Pelvic ring injuries form part of the spectrum of polytraumaandmust be considered a potentially lethal injury with mortality rates of 10–20%. The stabilization of the unstable pelvic ring in acute resuscitation of multiply injured patients is now conventional wisdom.We aimed: (1) to design a new iliosacral (IS) screw, (2) to prove the clinical advantages of this new implant, and (3) to work out the optimal surgical strategy using this implant. Taking the demands of the above mentioned data into account, a 10 mm 2.8 mm-cannulated iliosacral screw seemed to be optimal for the special requirements. Before industrial production, finite element analysis (FEA) was performed to find out whether these screws would be enough to stabilize the posterior pelvic ring alone or not. Clinical experience led to the modification of the set of instruments, which finally yielded handy tools and implants. Building further on the surgical skills and experiences gained (by the surgeons and the O.R. personnel), we increased our capacity to perform more and more immediate pelvic fixations. Emergency pelvic stabilizationswere performed in patientswith pelvic injuries who had hemodynamic instability, despite immediate shockmanagement during the diagnostic period. During thelast eleven years, 244 patientswith Tile B3 and Cpelvic injuries have been stabilized with 10-mm diameter cannulated IS screws percutaneously posteriorly. Fortyeight hemodynamically unstable patientswere stabilized in the first 2 h with iliosacral screw fixation. The percutaneous pelvic ring stabilization with 10-mm cannulated screws provedstrongenoughin bothersome casesaswell.