Acetabular and pelvic fractures in multiple trauma

Abstract

We see pelvic fractures in about 50% of all multiple trauma patients. In many cases, these pelvic fractures are complicated by complex pelvic traumata, i.e., a pelvic fracture with pelvic vessel damage, neurological, visceral or soft-tissue damage, and therefore have the character of life-threatening lesions. The incidence of complex pelvic trauma is extremely high in cases of vertical and rotation instability. Most problems come from massive bleeding as a result of presacral venous plexus laceration. This venous bleeding usually tampons its self after stabilization, e.g., with an external fixator. In about half of the cases an immediate laparotomy is performed because of remaining circulatory instability, lesions of the urinary tract, or open fractures. In these cases, stabilization of the pelvis is frequently achieved by ORIF, e.g., plating of the symphysis pubis or the SI joint. Internal stabilization of the pelvis facilitates the following treatment in the ICU, especially when prone-supine positioning is mandatory due to pulmonary indications. For this reason we avoid traction techniques in displaced acetabular fractures, and we achieve stability with a joint-bridging external fixator. Treatment of complex pelvic fracture must be integrated in the overall concept of treatment. Differentiated and situation-adapted action is necessary, depending on the particular situation, as well as the personnel and technical equipment.