Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 1/2016

01.02.2016 | Original Article

13-Year experience in external fixation of the pelvis: complications, reduction and removal

verfasst von: P. M. Mitchell, C. M. Corrigan, N. A. Patel, A. J. Silverberg, S. E. Greenberg, R. V. Thakore, W. T. Obremskey, J. M. Ehrenfeld, J. M. Evans, M. K. Sethi

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate the complications associated with anterior pelvic external fixation and the success of this device in maintaining reduction when used in conjunction with sacroiliac screws.

Methods

Through a retrospective clinical study at an academic Level I Trauma Center, 129 patients fit the criteria for inclusion with a mean duration of anterior pelvic external fixation of 62 days and mean follow-up of 360 days. Charts were reviewed for complications postoperatively. The symphysis diastasis, vertical displacement and posterior displacement of each hemipelvis were quantified from pelvic radiographs.

Results

Of the 129 patients receiving anterior pelvic external fixation, 14 (10.9 %) presented to an emergency department for problems with their anterior pelvic external fixation. Of these 14 patients, 7 (5.4 %) required readmission, all for infectious concerns necessitating IV antibiotics. 6 (4.7 %) required formal operative debridement and device removal. 13 patients (10.1 %) had superficial pin site infections successfully treated with oral antibiotics. Reduction was maintained (rated as fair, good or excellent) in all patients with radiographic follow-up (n = 74, average radiographic follow-up of 216 days) following removal of their anterior pelvic external fixation. 38 patients (30.4 %) had their anterior pelvic external fixation removed in clinic, while 87 (69.6 %) had formal removal in the operating room.

Conclusion

While previous data suggest high complication rates in definitive anterior pelvic external fixation, we present the largest cohort of patients receiving anterior pelvic external fixation and sacroiliac screws, demonstrating a low complication rate while maintaining reduction of the pelvic ring. In addition, we found that these devices could be reliably removed in a clinic setting.
Literatur
1.
Zurück zum Zitat Vaidya R, Kubiak EN, Bergin PF, et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012;470:2124–31.PubMedCentralCrossRefPubMed Vaidya R, Kubiak EN, Bergin PF, et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012;470:2124–31.PubMedCentralCrossRefPubMed
2.
Zurück zum Zitat Cole PA, Gauger EM, Anavian J, et al. Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures. J Orthop Trauma. 2012;26:269–77.CrossRefPubMed Cole PA, Gauger EM, Anavian J, et al. Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures. J Orthop Trauma. 2012;26:269–77.CrossRefPubMed
3.
Zurück zum Zitat Arazi M, Kutlu A, Mutlu M, et al. The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator. Arch Orthop Trauma Surg. 2000;120:584–6.CrossRefPubMed Arazi M, Kutlu A, Mutlu M, et al. The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator. Arch Orthop Trauma Surg. 2000;120:584–6.CrossRefPubMed
4.
Zurück zum Zitat Bellabarba C, Ricci WM, Bolhofner BR. Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma. 2006;20:S7–14.PubMed Bellabarba C, Ricci WM, Bolhofner BR. Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma. 2006;20:S7–14.PubMed
5.
Zurück zum Zitat Lindahl J, Hirvensalo E, Bostman O, et al. Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Jt Surg Br. 1999;81:955–62.CrossRef Lindahl J, Hirvensalo E, Bostman O, et al. Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Jt Surg Br. 1999;81:955–62.CrossRef
6.
Zurück zum Zitat Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Jt Surg Br. 1990;72:612–4. Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Jt Surg Br. 1990;72:612–4.
7.
Zurück zum Zitat Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36:599–604.CrossRefPubMed Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury. 2005;36:599–604.CrossRefPubMed
8.
Zurück zum Zitat Palmer S, Fairbank AC, Bircher M. Surgical complications and implications of external fixation of pelvic fractures. Injury. 1997;28:649–53.CrossRefPubMed Palmer S, Fairbank AC, Bircher M. Surgical complications and implications of external fixation of pelvic fractures. Injury. 1997;28:649–53.CrossRefPubMed
9.
Zurück zum Zitat Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma. 1993;35:671–5 discussion 676–677.CrossRefPubMed Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma. 1993;35:671–5 discussion 676–677.CrossRefPubMed
10.
Zurück zum Zitat Scaglione M, Parchi P, Digrandi G, et al. External fixation in pelvic fractures. Musculoskelet Surg. 2010;94:63–70.CrossRefPubMed Scaglione M, Parchi P, Digrandi G, et al. External fixation in pelvic fractures. Musculoskelet Surg. 2010;94:63–70.CrossRefPubMed
11.
Zurück zum Zitat Solomon LB, Pohl AP, Sukthankar A, et al. The subcristal pelvic external fixator: technique, results, and rationale. J Orthop Trauma. 2009;23:365–9.CrossRefPubMed Solomon LB, Pohl AP, Sukthankar A, et al. The subcristal pelvic external fixator: technique, results, and rationale. J Orthop Trauma. 2009;23:365–9.CrossRefPubMed
12.
Zurück zum Zitat Tucker MC, Nork SE, Simonian PT, et al. Simple anterior pelvic external fixation. J Trauma. 2000;49:989–94.CrossRefPubMed Tucker MC, Nork SE, Simonian PT, et al. Simple anterior pelvic external fixation. J Trauma. 2000;49:989–94.CrossRefPubMed
13.
Zurück zum Zitat Lefaivre KA, Slobogean G, Starr AJ, et al. Methodology and interpretation of radiographic outcomes in surgically treated pelvic fractures: a systematic review. J Orthop Trauma. 2012;26:474–81.CrossRefPubMed Lefaivre KA, Slobogean G, Starr AJ, et al. Methodology and interpretation of radiographic outcomes in surgically treated pelvic fractures: a systematic review. J Orthop Trauma. 2012;26:474–81.CrossRefPubMed
14.
Zurück zum Zitat Wild JJ Jr, Hanson GW, Tullos HS. Unstable fractures of the pelvis treated by external fixation. J Bone Jt Surg Am. 1982;64:1010–20. Wild JJ Jr, Hanson GW, Tullos HS. Unstable fractures of the pelvis treated by external fixation. J Bone Jt Surg Am. 1982;64:1010–20.
15.
Zurück zum Zitat Gunterberg B, Goldie I, Slatis P. Fixation of pelvic fractures and dislocations - experimental-study on loading of pelvic fractures and sacro-iliac dislocations after external compression fixation. Acta Orthop Scand. 1978;49:278–86.CrossRefPubMed Gunterberg B, Goldie I, Slatis P. Fixation of pelvic fractures and dislocations - experimental-study on loading of pelvic fractures and sacro-iliac dislocations after external compression fixation. Acta Orthop Scand. 1978;49:278–86.CrossRefPubMed
16.
Zurück zum Zitat Simonian PT, Routt MLC, Harrington RM, et al. Anterior versus posterior provisional fixation in the unstable pelvis—a biomechanical comparison. Clin Orthop Relat Res. 1995;1995:245–51. Simonian PT, Routt MLC, Harrington RM, et al. Anterior versus posterior provisional fixation in the unstable pelvis—a biomechanical comparison. Clin Orthop Relat Res. 1995;1995:245–51.
17.
Zurück zum Zitat 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;21:435–41.CrossRefPubMed 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;21:435–41.CrossRefPubMed
18.
19.
Zurück zum Zitat Hutson JJ, Zych GA. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma. 1998;12:214–8.CrossRefPubMed Hutson JJ, Zych GA. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma. 1998;12:214–8.CrossRefPubMed
20.
Zurück zum Zitat Mahan J, Seligson D, Henry SL, et al. Factors in pin tract infections. Orthopedics. 1991;14:305–8.PubMed Mahan J, Seligson D, Henry SL, et al. Factors in pin tract infections. Orthopedics. 1991;14:305–8.PubMed
21.
Zurück zum Zitat Masse A, Bruno A, Bosetti M, et al. Prevention of pin track infection in external fixation with silver coated pins: clinical and microbiological results. J Biomed Mater Res. 2000;53:600–4.CrossRefPubMed Masse A, Bruno A, Bosetti M, et al. Prevention of pin track infection in external fixation with silver coated pins: clinical and microbiological results. J Biomed Mater Res. 2000;53:600–4.CrossRefPubMed
22.
Zurück zum Zitat Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17:503–7.CrossRefPubMed Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17:503–7.CrossRefPubMed
23.
Zurück zum Zitat Gardner MJ, Nork SE. Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 2007;21:269–73.CrossRefPubMed Gardner MJ, Nork SE. Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 2007;21:269–73.CrossRefPubMed
24.
Zurück zum Zitat 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;21:435–41.CrossRefPubMed 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;21:435–41.CrossRefPubMed
25.
Zurück zum Zitat DiCicco JD, Ostrum RF, Martin B. Office removal of tibial external fixators: an evaluation of cost savings and patient satisfaction. J Orthop Trauma. 1998;12:569–71.CrossRefPubMed DiCicco JD, Ostrum RF, Martin B. Office removal of tibial external fixators: an evaluation of cost savings and patient satisfaction. J Orthop Trauma. 1998;12:569–71.CrossRefPubMed
26.
Zurück zum Zitat Ryder S, Gorczyca JT. Routine removal of external fixators without anesthesia. J Orthop Trauma. 2007;21:571–3.CrossRefPubMed Ryder S, Gorczyca JT. Routine removal of external fixators without anesthesia. J Orthop Trauma. 2007;21:571–3.CrossRefPubMed
Metadaten
Titel
13-Year experience in external fixation of the pelvis: complications, reduction and removal
verfasst von
P. M. Mitchell
C. M. Corrigan
N. A. Patel
A. J. Silverberg
S. E. Greenberg
R. V. Thakore
W. T. Obremskey
J. M. Ehrenfeld
J. M. Evans
M. K. Sethi
Publikationsdatum
01.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 1/2016
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0499-7

Weitere Artikel der Ausgabe 1/2016

European Journal of Trauma and Emergency Surgery 1/2016 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie.

Erweitert durch Fallbeispiele, Videos und Abbildungen.


Jetzt entdecken!

Krillöl hilft nicht gegen Kniearthrose

13.06.2024 Arthrosen Nachrichten

Mit Krillöl zur Nahrungsergänzung lassen sich Schmerzen und Entzündungen bei Kniearthrose nicht stärker lindern als unter Placebo. Das hat eine kontrollierte Studie mit über 260 Betroffenen ergeben.

Zwei Wochen nach Sprunggelenksfraktur wieder belasten?

12.06.2024 Sprunggelenkfraktur Nachrichten

Nach einer Sprunggelenksfraktur kann es ratsam sein, das Bein bereits zwei Wochen postoperativ wieder zu belasten. In einer randomisierten Studie war diese Strategie funktionell nicht von Nachteil, und auch die Komplikationsrate war annähernd gleich.

Notfallreform: Lauterbach nimmt KVen und ausgewählte Kliniken in die Pflicht

06.06.2024 Klinik aktuell Nachrichten

Die Ampelkoalition nimmt einen neuen Anlauf für die Reform der Notfallversorgung. Der Gesetzentwurf zeigt: Die Vertragsärzte müssen sich auf erhebliche Veränderungen in der Organisation der Notdienste einstellen.

Tennisarm: „Ein bisschen Physio würde ich mich schon trauen“

06.06.2024 Schmerzsyndrome Nachrichten

Eine Therapie mit nachgewiesenem Nutzen gibt es bei Epicondylitis lateralis derzeit nicht. Das heißt jedoch nicht, dass man die Betroffenen mit ihren Beschwerden allein lassen sollte, so der Rat eines Experten. Gute Erfahrungen habe er zum Beispiel mit der Stoßwellentherapie gemacht.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.