Surgical Approach

The patient is usually positioned either supine or floppy lateral, depending on the potential for a combined posterior approach. If a lateral position is chosen, a beanbag is most often used for stability and can be deflated, allowing the patient to fall back to a more supine position once the patient has been prepped and draped. Alternatively, the patient can be left lateral and a true simultaneous anterior and posterior dissection can take place utilizing two experienced surgeons, although...

Anterior Column Posterior Hemitransverse Fractures

While there is a posterior fracture that separates the posterior column and, similarly, a disruption of the anterior column, there must remain a portion of the roof and superior posterior wall that remains attached to the ilium. This is an essential differentiating feature from the both-column fracture pattern. Also, the anterior portion of the fracture has the characteristics of anterior column fractures. In the T fracture, there is a necessary extension into the obturator foramen as well as...

Soft Tissue Complications and Infection

Acetabular fracture surgery initially had high infection rates. Letournel, in his early series, reported a 30 incidence of surgical wound infection (70-72). With the use of prophylactic antibiotics and improved soft tissue management, the surgical infection rates have fallen dramatically to 2 to 5 in most large series (2,3,10,43,73 -77). However, obese patients, patients with ipsilateral open fractures, patients with visceral injuries, patients with nutritional compromise, patients with some...

Acetabular Reconstruction Fixation Methods in Associated Fracture Patterns

Anterior Posterior Acetabular Screw

Department of Orthopaedic Trauma, St. Elizabeth Health Center and Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Youngstown, Ohio, U.S.A. Daniel R. Schlatterer and Robert M. Harris Department of Orthopaedic Trauma, Atlanta Medical Center, Atlanta, Georgia, U.S.A. INTRODUCTION TO ASSOCIATED FRACTURE PATTERNS OF THE ACETABULUM The associated patterns of acetabular fractures were described by Letournel and are described elsewhere in this text. They tend to...

Info

Figure 10 (Continued) (C) Axial CT scan at level of anterior inferior iliac spine. Note how a screw placed at this level will be nearly perpendicular to the transverse fracture line. (D) Obturator outlet fluoroscopy image demonstrating guide wire position within iliac inner and outer tables and just cephalad to the hip joint. The Farabeuf clamp is used to effect a reduction (not shown), and the iliac oblique view (E) can provide an end-on view of the anterior column to facilitate screw...

Sexual Functioning

Pelvic fractures have also been shown to affect genitourinary and sexual functioning in both males and females. These effects have been found to be both physiological and psychological in nature. All studies have reported that pelvic fractures create a risk for genitourinary and sexual dysfunction, and that multifactorial, genitourinary, and sexual dysfunction have been shown to have a profound impact on a person's life. In males, sexual function following pelvic fracture has been studied in...

Acute Management of Pelvic Fractures A European Perspective

Gansslen and Christian Krettek Department of Trauma, Hannover Medical School, Hannover, Germany Hans-Christoph Pape Department of Orthopaedic Surgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, U.S.A. Department of Urology, Hannover Medical School, Hannover, Germany During resuscitation of polytrauma patients with associated pelvic injuries, a specific subgroup, characterized by unstable pelvic fractures combined with a hemodynamic instability related to the...

Beginnings Of Operative Management

In the early 1940s, Levine reported the early successful results of open reduction and internal fixation of a central fracture of the acetabulum (11). Review of his case reports revealed a both-column acetabular fracture, which at the time was treated through a Smith-Peterson approach with a plate on the internal iliac fossa. Although his report had relatively short follow-up, it was one of the first to advocate a more aggressive treatment. Prior to the 1940s, acetabular fractures were...

Emergency Surgery

Erectile Fracture

The emergency surgical management of patients with mechanically unstable pelvic injuries and hypovolemic shock begins in the emergency room. Advanced trauma lifesupport teaching is now widely applied 9 . Shock recognition is followed by search for the source of hemorrhage while volume resuscitation is initiated. Clues to the nature of pelvic injuries are obtained from the history of injury e.g., a fall from a height or a motorcyclist sustaining a straddle injury and physical examination....

Anterolateral Approach To The Iliac Wing

The anterolateral Olerud approach, corresponding to the first window of the ilioinguinal Letournel approach Fig. 2 , allows exposure of the iliac wing and direct access to the anterior part of the SI joint. This approach is used for reduction and fixation of iliac wing fractures, transiliosacral crescent fractures, and disruptions of the SI joint. Apart from excellent direct visual control of these anatomical structures, optimal guidance of the drilling direction close to the SI joint is...