Pelvic Binder Utilization in Combat Casualties: Does It Matter?

2020 ◽  
Vol 86 (7) ◽  
pp. 873-877
Author(s):  
William J. Parker ◽  
Robert W. Despain ◽  
Adam Delgado ◽  
Carlos J. Rodriguez ◽  
Dean Baird ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Combat Trauma ◽  
Blood Component ◽  
Total Blood ◽  
Pubic Symphysis Diastasis ◽  
Pelvic Binder ◽  
Initial Imaging ◽  
Combat Casualties

Introduction The purpose of this study was to evaluate the utilization of pelvic binders, the proper placement of binders, and to determine any differences in blood product transfusions between combat casualties with and without a pelvic binder identified on initial imaging immediately after the injury. Methods We conducted a retrospective review of all combat-injured patients who arrived at our military treatment hospital between 2010 and 2012 with a documented pelvic fracture. Initial imaging (X-ray or computed tomography) immediately after injury were evaluated by 2 independent radiologists. Young-Burgess (YB) classification, pelvic diastasis, correct binder placement over the greater trochanters, and the presence of a pelvic external fixator (ex-fix) was recorded. Injury severity score (ISS), whole blood, and blood component therapy administered within the first 24-hours after injury were compared between casualties with and without a pelvic binder. Results 39 casualties had overseas imaging to confirm and radiographically classify a YB pelvic ring injury. The most common fracture patterns were anteroposterior (53%) and lateral compression (28%). 49% (19/39) did not have a binder or ex-fix identified on initial imaging or in any documentation after injury. Ten patients had a binder, with 30% positioned incorrectly over the iliac crest. ISS (34 ± 1.6) was not statistically different between the binder and the no-binder group. Pubic symphysis diastasis was significantly lower in the binder group (1.4 ± 0.2 vs 3.7 ± 0.5, P < .001). There was a trend toward decreased 24-hour total blood products between the binder and no-binder groups (75 ± 11 vs 82 ± 13, P = .67). This was due to less cryoprecipitate in the binder group (6 ± 2 vs 19 ± 5, P = .01). Conclusions Pelvic binder placement in combat trauma may be inconsistent and an important area for continued training. While 24-hour total transfusions do not appear to be different, no-binder patients received significantly more cryoprecipitate.

scholarly journals Traumatic Pelvic Ring Injury following Childbirth with Complete Pubic Symphysis Diastasis

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Aaron Seidman ◽  
Kelley Brossy ◽  
Alfred Faulkner ◽  
Jeffrey Taylor
Keyword(s):  
Medical Decision Making ◽  
Nonoperative Management ◽  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Medical Decision ◽  
Pelvic Ring Injury ◽  
Pubic Symphysis Diastasis ◽  
Orthopedic Injuries ◽  
Uniform Treatment

Case. Traumatic pelvic ring injury following childbirth is a rare but debilitating condition. We present a case of a 28-year-old female who sustained a traumatic pelvic ring injury following childbirth with a complete pubic symphysis separation of 5.6 cm treated successfully with nonoperative management. Conclusion. Operative and nonoperative treatments for traumatic pelvic ring injuries following childbirth have been described without universal adoption of a uniform treatment modality. We hope this case study adds to the collection of data to help guide medical decision-making in the future as surgeons encounter patients with similar orthopedic injuries.

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

scholarly journals Trans-obturator cable fixation of open book pelvic injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Martin C. Jordan ◽  
Veronika Jäckle ◽  
Sebastian Scheidt ◽  
Fabian Gilbert ◽  
Stefanie Hölscher-Doht ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Pubic Symphysis ◽  
Cadaver Study ◽  
Steel Cable ◽  
Reliable Technique ◽  
Peak Displacement ◽  
Total Displacement ◽  
Cable Fixation

AbstractOperative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

scholarly journals Failure of Internal Fixation of The Anterior Ring For Unstable Pelvic Fractures, The Experience of A Single Institute

2021 ◽  
Author(s):  
Sheng Zhang ◽  
Huagui Mo ◽  
Yucheng Liu ◽  
Guohua Zhu ◽  
Bin Yu
Keyword(s):  
Internal Fixation ◽  
Pelvic Ring ◽  
Treatment Strategies ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Fixation Failure ◽  
Initial Surgery ◽  
Multidisciplinary Cooperation ◽  
Preoperative Plan ◽  
Anterior Ring

Abstract Background: This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials: From January 2009 to December 2018, 93 patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system.Results: According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5-28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients were fixed with a plate. Five patients undergoing revision surgery were followed up for 6-36 months with an average of 18 months. According to Majeedscore at the last follow-up, there were 2 cases of excellent, 2 cases of good, 1 case of fair, and the excellent and good rate reached 80%.Conclusion: The treatment of complicated unstable pelvic fractures requires early multidisciplinary cooperation, proper management of hemodynamic stability and other comorbidities, and performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

scholarly journals PUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)

2018 ◽  
Vol 24 (3) ◽  
pp. 145-156
Author(s):  
A. L. Petrushin ◽  
A. V. Pryaluchina
Keyword(s):  
Internal Fixation ◽  
Treatment Options ◽  
Pubic Symphysis ◽  
Lower Limbs ◽  
Sacroiliac Joints ◽  
Pubic Symphysis Diastasis ◽  
Partial Load ◽  
Short Period ◽  
Pregnancy And Delivery ◽  
Symphysis Diastasis

Purpose of the study— to generalize and arrange the data published in scientific literature and to present currentviews on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.

scholarly journals Pubic Symphysis Diastasis: A Case Series and Literature Review

2017 ◽  
Vol 32 (6) ◽  
pp. 510-514 ◽  
Author(s):  
Jaya Jethra Chawla ◽  
Devendra Arora ◽  
Namrita Sandhu ◽  
Megha Jain ◽  
Anju Kumari
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Pubic Symphysis ◽  
Pubic Symphysis Diastasis ◽  
Symphysis Diastasis

Military experience in the management of pelvic fractures from OIF/OEF

2020 ◽  
pp. bmjmilitary-2020-001469
Author(s):  
William Parker ◽  
R W Despain ◽  
J Bailey ◽  
E Elster ◽  
C J Rodriguez ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Pelvic Fracture ◽  
External Fixator ◽  
Injury Severity ◽  
Fracture Pattern ◽  
Injury Pattern ◽  
Pelvic Fractures ◽  
Vertical Shear ◽  
Treatment Modalities ◽  
Pelvic Binder

IntroductionPelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.MethodsWe conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.ResultsOf 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.ConclusionsPelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

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