Pelvic fracture treatment can be done with these two methods

Fractures often occur in our lives. When they occur in different parts of the body, the first aid and coping methods people can take will be slightly different. So, how should pelvic fractures be treated?

1. First Aid

The main treatment is for shock and various life-threatening complications. Pelvic fractures are often accompanied by multiple injuries, accounting for 33% to 72.7%, and the incidence of shock is as high as 30% to 60%. The mortality rate of severe pelvic fractures is 25% to 39%, all of which are caused by direct or indirect pelvic fracture bleeding. Therefore, the early treatment of pelvic fractures must follow the basic principles of advanced traumatic life support, first save lives, stabilize vital signs, and then conduct corresponding inspections and treatments for pelvic fractures. Once it is determined that shock is caused by pelvic fracture bleeding, treatment should be carried out according to the rescue process of pelvic fractures. Early external fixation is very meaningful for the rescue of hemorrhagic shock caused by pelvic fractures. Effective external fixation methods include external fixator-fixed anterior ring, C-clamp-fixed posterior ring. If there is a lack of fixation equipment, simply wrapping and fixing the pelvis with sheets, chest and abdominal belts, etc. can also play a certain role in stabilizing the pelvis and stopping bleeding. If blood pressure still cannot be maintained, open abdominal packing compression hemostasis or angiography arterial embolization should be used.

2.Surgery

(1) The best time to perform surgery is within 7 days after injury, and no later than 14 days. Otherwise, the difficulty of reduction will be greatly increased, and the incidence of malunion and nonunion will also increase significantly.

(2) Select treatment methods based on fracture classification. Type A pelvic fractures in the AO classification are stable fractures and are generally treated conservatively, with bed rest for 4 to 6 weeks and early walking and exercise. Type B fractures are anterior ring injuries and only require anterior fixation. Type C fractures are posterior ring or anterior-posterior combined pelvic ring injuries and require anterior-posterior combined pelvic ring fixation.

(3) Indications for surgery: ① Failure of closed reduction; ② Residual displacement after external fixation; ③ Symphysis pubis separation greater than 2.5 cm or symphysis interlocking; ④ Vertically unstable fracture; ⑤ Combined acetabular fracture; ⑥ Severe pelvic rotation deformity leading to lower limb rotation dysfunction; ⑦ Damage and displacement of the posterior pelvic ring structure >1 cm, or pubic displacement combined with posterior pelvic instability and shortening of the affected limb >1.5 cm; ⑧ Open posterior injury without perineal contamination; ⑨ Symphysis ramus fracture combined with femoral nerve and blood vessel damage; ⑩ Open fracture.

(4) Surgical method

1) Anterior fixation is used to fix anterior ring instability, and is commonly used for symphysis diastasis and symphysis rami fractures. The surgical indications are: a. symphysis diastasis greater than 2.5 cm; b. symphysis interlocking; c. symphysis rami fracture combined with femoral nerve and blood vessel damage; d. open symphysis rami fracture; e. combined with posterior pelvic instability.

The main fixation methods are external fixators, pubic reconstruction plates, and hollow tension screws.

2) Posterior fixation is used to fix the instability of the posterior ring, and is often used for sacroiliac joint separation, sacral fracture, etc. The surgical indications are: a. Vertical unstable fracture; b. Pelvic posterior ring structure damage displacement > 1cm; c. Open posterior injury without perineal contamination; d. Combined acetabular fracture.

The main fixation methods are: C-clamp, presacral steel plate fixation; posterior sacral sacral bolt, sacral steel plate, and sacral tension screw fixation.