Unstable Pelvis Research Articles

Improving surgical technical skills for emergency fixation of unstable pelvic ring fractures: an experimental study using a pelvic ring fracture simulator

BackgroundThe management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement. Given the infrequent performance of these procedures, regular training is imperative to ensure readiness for emergencies. Our pre- post simulation study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries, facilitating participants’ knowledge retention and procedural confidence enhancement.MethodsA standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint was developed. Trauma surgeons of a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated as secondary outcome measures.ResultsFifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The mean total operation time was 20.34 ± 6.06 min, without significant differences between consultants and residents (p = 0.604). The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before = 3.8 ± 3.08 vs. After = 5.67 ± 2.35; p = 0.002) as well as after external fixation (10-LS: Before = 3.93 ± 2.79 vs. After = 6.07 ± 2.52; p = 0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before = 4.60 ± 3.0 vs. After = 6.53 ± 2.39; p = 0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS = 7.87 ± 1.13).ConclusionsOur unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging. Further studies are required to validate the objective benefits and improvements that participants undergo through frequent training.

Anterior internal versus external fixation of unstable pelvis fractures was not associated with discharge destination, critical care, length of stay, or hospital charges

PurposeDetermine if anterior internal versus supra-acetabular external fixation of unstable pelvic fractures is associated with care needs or discharge.MethodsA retrospective cohort study was performed at two tertiary trauma referral centers. Adults with unstable pelvis fractures (AO/OTA 61B/61C) who received operative fixation of the anterior and posterior pelvic ring by two orthopedic trauma surgeons from October 2020 to November 2022 were included. The primary outcome was discharge destination. Secondary outcomes included intensive care unit (ICU) or ventilator days, length of stay, and hospital charges.ResultsEighty-three eligible patients were 38.6% female, with a mean age of 47.2 ± 20.3 years and BMI 28.1 ± 6.4 kg/m2. Fifty-nine patients (71.1%) received anterior pelvis internal fixation and 24 (28.9%) received external fixation. External fixation was associated with weight-bearing restrictions (91.7% versus 49.2%, p = 0.01). No differences in demographic, functional status, insurance type, fracture classification, or injury severity measures were observed by treatment. Internal versus external anterior pelvic fixation was not associated with discharge to home (49.2% versus 29.2%, p = 0.10), median ICU days (3.0 [interquartile range (IQR) 7.8 versus 5.5 [IQR 4.3], p = 0.14, ventilator days (0 [IQR 6.0] versus 0 [IQR 2.8], p = 0.51), length of stay (13.0 [IQR 13.0] versus 17.5 (IQR 20.5), p = 0.38), or total hospital charges (US dollars 180,311 [IQR 219,061.75] versus 243,622 [IQR 187,111], p = 0.14).ConclusionsAnterior internal versus supra-acetabular external fixation of unstable pelvis fractures was not significantly associated with discharge destination, critical care, hospital length of stay, or hospital charges. This sample may be underpowered to detect differences between groups.Level of EvidenceTherapeutic Level IV.

Immediate management of a stable patient with unstable pelvis.

The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion. For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding. The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient's general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

Insidious, deadly, common - polytrauma with pelvic fracture

Polytrauma patients with pelvic injuries have a high mortality rate, particularly in those who are haemodynamically unstable, reaching up to 42%. This case study involves a 66-year-old cyclist struck by a tram in Gdańsk, Poland in October 2022. Upon arrival at the Emergency Department of the Medical University of Gdańsk, the patient exhibited stability but later entered the initial shock phase. Comprehensive imaging unveiled flail chest, bilateral pneumothorax, spinal fractures, and an unstable pelvis. Despite a negative point-of-care ultrasound, the planned orthopaedic pelvic stabilization surgery transitioned to endovascular intervention due to deteriorating shock and suspected retroperitoneal bleeding. Despite a successful procedure, the patient succumbed to irreversible shock and multiple organ failure the next day in the intensive care unit. The significance of rapid identification of internal bleeding followed by timely endovascular intervention and retroperitoneal pelvic packing is underscored, as it has demonstrated decreased mortality in similar cases.

Biomechanical analysis of sacroiliac joint motion following oblique-pulling manipulation with or without pubic symphysis injury

Background: Oblique-pulling manipulation has been widely applied in treating sacroiliac joint (SIJ) dysfunction. However, little is known about the biomechanical mechanism of the manipulation. This study aims to analyze the SIJ motion under oblique-pulling manipulation, in comparison with compression and traction loads. Methods/Study Design: A total of six specimens of embalmed human pelvis cadavers were dissected to expose the SIJ and surrounding ligaments. Through a servo-hydraulic testing system, biomechanical tests were performed on the stable pelvis and the unstable pelvis with pubic symphysis injury (PSI). A three-dimensional (3D) photogrammetry system was employed to determine the separation and nutation in three tests: axial compression (test A), axial traction (test B), and oblique-pulling manipulation (test C). Results: After applying the testing loads, the range of nutation was no more than 0.3° (without PSI) and 0.5°(with PSI), separately. Except for test B, a greater nutation was found with PSI (p < 0.05). Under both conditions, nutation following test A was significantly greater than that of other tests (p < 0.05). SIJ narrowed in test A and separated in tests B and C, where the range of motion did not exceed 0.1 mm (without PSI) or 0.3 mm (with PSI) separately. Under both conditions, the separation of SIJ in test C was not as apparent as the narrowness of SIJ in test A (p < 0.05). Compared to SIJ, a more significant increasing displacement was found at the site of the iliolumbar ligament (p < 0.05). Nevertheless, when the force was withdrawn in all tests, the range of nutation and separation of SIJ nearly decreased to the origin. Conclusion: Pubic symphysis is essential to restrict SIJ motion, and the oblique-pulling manipulation could cause a weak nutation and separation of SIJ. However, the resulting SIJ motion might be neutralized by regular standing and weight-bearing load. Also, the effect on SIJ seems to disappear at the end of manipulation. Therefore, the stretching and loosening of surrounding ligaments need to be paid more attention to.

Quantification and visualization of anterior pelvis bone density to optimize screw fixation: A novel technique.

Plate fixation of anterior pelvic ring fractures is often a vital component when surgically treating unstable pelvis fractures. Certain plate and screw configurations can have premature implant loosening, potentially in part due to insufficient pullout strength in lower density bone. This study sought to define densities about the anterior pelvic ring using a novel computer-based technique. Thirty-three patients who received a computed tomography (CT) of the abdomen/pelvis for reasons other than pelvis fracture in a 1-month time period were included. Three statistically distinct density regions of the anterior pelvis were identified based on the three-dimensional (3D) density map. The densest regions included both the anterior and posterior aspects of the superior pubic ramus, along with the region of bone along the inferior cotyloid fossa. The intermediate density region included the caudal and medial pubic body. The least dense region included the anterior aspect of the inferior pubic ramus (IPR), the posterior pubic body, and the posterior/inferior IPR. This study presents specific quantification of anterior pelvis bone density based on a novel technique using opportunistic CT scans. Clinical Significance: Anterior surgical fixation of unstable pelvic ring injuries may benefit from targeting areas of higher density as described in this novel technique.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

Quantifying the Effect of Pelvis Fracture on Lumbar Spine Compression during High-rate Vertical Loading.

Fracture to the lumbo-pelvis region is prevalent in warfighters seated in military vehicles exposed to under-body blast (UBB). Previous high-rate vertical loading experimentation using whole body post-mortem human surrogates (PMHS) indicated that pelvis fracture tends to occur earlier in events and under higher magnitude seat input conditions compared to lumbar spine fracture. The current study hypothesizes that fracture of the pelvis under high-rate vertical loading reduces load transfer to the lumbar spine, thus reducing the potential for spine fracture. PMHS lumbo-pelvis components (L4-pelvis) were tested under high-rate vertical loading and force and acceleration metrics were measured both inferior-to and superior-to the specimen. The ratio of inferior-tosuperior responses was significantly reduced by unstable pelvis fracture for all metrics and a trend of reduced ratio was observed with increased pelvis AIS severity. This study has established that pelvis fracture reduces compression forces at the lumbar spine during high-rate vertical loading, thus reducing the potential for fracture to the lumbar spine. Therefore, pelvis injury potential should be considered when implementing lumbar injury criteria specific to UBB.

Фиксация таза при повреждении заднего полукольца у пострадавших с политравмой

Background Unstable pelvis injuries are one of the most difficult and severe trauma of musculoskeletal system that needs emergency measures. Aim of the study is the optimization of treatment tactics in unstable pelvis fractures in polytrauma patients. Маterial and methods This is a prospective study of treatment results of 96 polytrauma patients with unstable pelvic fractures type C. Unilateral injuries of the posterior pelvic ring were 85.42 % (n = 82), bilateral injuries were 14.58 % (n = 14) of cases. Diagnostic complex included physical examination, laboratory tests, X-rays and CT. Examination was carried out simultaneously with anti-shock measures and intensive care. Primary basic stabilization of the pelvis with an external device and fixation of the posterior ring were performed. Results and discussions Three patients died (3.13 %), the remaining 93 (96.87 %) patients completed treatment with good outcomes. The biomechanics of pelvic injuries shows us the necessity of external fixation. Unstable pelvis injuries in polytrauma patients with hemodynamic instability should be temporary stabilized to decrease the intrapelvic volume. Conclusions Primary stabilization of the pelvic ring is an effective therapeutic tactic that leads to a significant reduction in the severity of patients’ condition, prevention of post-traumatic complications and early functional recovery of the damaged organs.

Life over limb: Arterial access-related limb ischemic complications in 48-hour REBOA survivors.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used in some trauma settings. Arterial access-related limb ischemic complications (ARLICs) resulting from the femoral arterial access required for REBOA are largely under reported. We sought to describe the incidence of these complications and the clinical, technical, and device factors associated with their development. This was a retrospective cohort study of records of adult trauma patients from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute care surgery registry between October 2013 and September 2020 who had REBOA and survived at least 48 hours. The primary outcome was ARLIC, defined as clinically relevant extremity ischemia or distal embolization. Relevant factors associated with ARLIC were also analyzed. Of 418 identified patients, 36 (8.6%) sustained at least one ARLIC; 22 with extremity ischemia, 25 with distal embolism, 11 with both. Patient demographics and injury characteristics were similar between ARLIC and no ARLIC groups. Access-related limb ischemic complication was associated with larger profile devices (p = 0.009), cutdown access technique (p = 0.02), and the presence of a pelvic external fixator/binder (p = 0.01). Patients with ARLIC had higher base deficit (p = 0.03) and lactate (p = 0.006). One hundred fifty-six patients received tranexamic acid (TXA), with 22 (14%) ARLICs. The rate of TXA use among ARLIC patients was 61% (vs. 35% TXA for non-ARLIC patients, p = 0.002). Access-related limb ischemic complication did not result in additional in-hospital mortality, however, ARLIC had prolonged hospital LOS (31 vs. 24 days, p = 0.02). Five ARLIC required surgical intervention, three patch angioplasty (and two with associated bypass), and four ARLIC limbs were amputated. Femoral artery REBOA access carries a risk of ARLIC, which is associated with unstable pelvis fractures, severe shock, and strongly with the administration of TXA. Use of lower-profile devices and close surveillance for these complications is warranted in these settings and caution should be exercised when using TXA in conjunction with REBOA. Prognostic and Epidemiologic, Level III.

Treatment of Unstable Injury of Pelvic Bones in Pregnant (Case Report)

Summary. There is no doubt in the relevance of the problem of treatment of patients with unstable fractures of pelvic bones, since these injuries involve a threat to the patient's life in the early period and often lead to disability in the future. This article presents a rare case of treatment of a patient with an unstable pelvis injury, while being 16 weeks pregnant. Patient A., born 1993, was admitted after a road accident injury. The examinations included: X-ray, CT, ultrasound, and gynecologist consultation. The patient was diagnosed with closed bilateral fracture of the pubic and ischial bones with displacement; rupture of the left sacroiliac joint with the boundary fracture of the sacrum (61-С1.3 by the Tile-AO-ASIF classification). The patient was 16 weeks pregnant. The surgery – open reduction and extramedullary metalosteosynthesis – was performed at the 9th day after the injury. The patient was discharged to outpatient treatment at the 12th day after the surgery. She started walking on crutches 3 weeks after the surgery; no additional support was needed since 1.5 months after the surgery. The patient gave birth at 39 weeks by surgical intervention (caesarean section). The baby's condition was assessed as 8 according to the Apgar scale. At the control examination 10 months after the surgery, musculoskeletal function of the patient was fully restored.

The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

BackgroundIt is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination.MethodsMedical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients’ baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system.ResultsIn total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039).ConclusionsThe ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination.Level of evidenceLevel III.

Fractura de pelvis inestable. Estudio de cohorte longitudinal

BackgroundThere is no consensus about treatment for patients with an unstable pelvic fracture and even less when hemodynamic instability is associated with. Study was conducted to determine the outcome in the management of patients with an unstable fracture of the pelvis, with or without hemodynamic instability, in a trauma referral center in Medellín, Colombia. MethodsA retrospective, longitudinal cohort study was conducted including patients with pelvic fracture due to trauma. Demographic data, vital signs on admission, presence of hemodynamic shock on admission (according to the ATLS scale), method of bleeding control, transfusion requirement and overall mortality rate were collected. An analysis was performed on a subgroup of patients who presented with signs of associated severe hemodynamic shock, defined as ATLS III-IV upon admission and a requirement for blood products of more than 8IU in the first 48hours. ResultsA total of 567 patients with any type of pelvic fracture, between January 2011 and December 2018, identified in the institution's databases, of which 149 patients presented an unstable pelvic fracture pattern (FIP). 68.1% of the patients were male, with a mean age of 34 IQR; 30 years and an Injury Severity Score (ISS) of 34 IQR: 20. Hospital mortality was 13.3%. Angioembolization and external fixator placement were the most used method of bleeding control. A total of 37 patients (27%) underwent intervention to control bleeding in the first 48hours. There were 37 patients with pelvic fracture admitted in a state of severe shock or requiring more than 8U of blood products, 17 patients required intervention in the pelvis, using single or combined ways. The mortality calculated for these patients was 32%. DiscussionPatients with unstable pelvis fractures admitted to our institution have a high mortality rate and it is even higher in patients who present with severe shock. Various methods were used to control bleeding similar to those indicated in the current literature. We require a sustained institutional effort to treat pelvic fractures and reduce the mortality of our patients, and knowing our population characteristcs allows us to guide management strategies.Evidence Level: III

The Mechanical Response and Tolerance of the Anteriorly-Tilted Human Pelvis Under Vertical Loading

Military vehicle underbody blast (UBB) is the cause of many serious injuries in theatre today; however, the effects of these chaotic events on the human body are not well understood. The purpose of this research was to replicate UBB loading conditions on the human pelvis and investigate the resulting response in a controlled laboratory setting. In addition to better understanding the response of the human pelvis to high rate vertical loading, this test series also aimed to identify high rate injury thresholds. Twenty-seven post mortem human surrogate (PMHS) component pelvis tests were completed using the University of Virginia's (UVa) simulated blast rig under a range of loading conditions and postures. Of those tests, 17 were in the anteriorly-tilted posture and used to construct the human injury probability curve. Average seat pan (rigid) accelerations for this subset of tests ranged from 300 to 2400 g over 2 to 3 ms of positive phase duration. Post-test computed tomography (CT) scans and necropsies were performed to determine injuries and revealed a frequent occurrence of anterior and posterior injuries, resulting in unstable pelvis ring fractures. The resulting Human Injury Probability Curve (HIPC) yielded mean forces of 5529, 8516, and 12431 N as measured by mass compensated seat platen loadcells applied through the rigid seat to the bilateral ischium are associated with a 10, 25, and 50% risk for unstable pelvic ring sacrum fractures in an anteriorly-tilted pelvis (28° from vertical), respectively.

Diagnostic accuracy of pubic symphysis ultrasound in the detection of unstable pelvis in polytrauma patients during e-FAST: the value of FAST-PLUS protocol. A preliminary experience.

Extended focused abdominal sonography for trauma (e-FAST) is part of the primary survey in patients with high-energy trauma. However, it does not identify patients with retroperitoneal haemorrhage associated with significant pelvic trauma. A traumatic diastasis of pubic symphysis, as well as an 'open book' (OB) pelvic injury, is a diagnostic clueto recognize unstable pelvis with higher risk of bleeding. FAST-PLUS (FAST-PL pleural -US ultrasound of symphysis) protocol is an addendum to the e-FAST, which takes into account the study of the pubic symphysis in a single transverse scan after the traditional focused evaluation of the abdomen and thorax. The aim of this study is to determine the value of FAST-PLUS protocol in the evaluation of pubic symphysis injuries and the identification of 'open book' (OB) unstable pelvic fractures. Between January 2018 and December 2019, we retrospectively reviewed 67 polytraumatised patients with clinical suspicion of pelvic instability and with known anteroposterior pelvis compression injuries who underwent e-FAST with an additional transverse scan of the pubic symphysis, named the FAST-PLUS protocol and computed tomography (CT) exam in order to assess the correlation between them in defining the presence or absence of pubic symphyseal widening (SW). A cutoff value of 2.5cm in transverse diameter was used to diagnose OB unstable pelvic injury. The results were analysed using Cohen's test, which uses the Kappa value as the reference index. The analysis carried out to assess the degree of agreement between FAST-PLUS and CT showed 5/67 patients (7.5%) with a critical pubic SW (> 2.5cm transverse diameter) suggestive of unstable OB pelvic injury and 62/67 (92,5%) without any signs of SW at FAST-PLUS. At CT, findings of unstable OB pelvic fracture were confirmed in all patients with positive results at FAST-PLUS. Similarly, all patients with negative results for critical pubic SW (< 2.5cm in transverse diameter) at FAST-PLUS were found to be negative at CT exam. The level of correlation between the two methods was high (Kappa value = 1) CONCLUSION: The FAST-PLUS protocol shows a high correlation with CT exam, which is the gold standard for the detection of unstable pubic SW, as well as OB pelvic injury, in polytraumatised patients. Inclusion of FAST-PLUS in patient management in the shock room may lead to a quicker identification of patients with unstable pelvis and to faster therapeutic work-up.

PELVIC RING INJURY ASSOCIATED WITH FLOATING KNEE AND IPSILATERAL POSTERIOR CRUCIATE LIGAMENT (PCL) AVULSION FRACTURE: AN EXPERIENCE

Pelvic ring injury associated with floating knee is relatively rare1. For our best acquaintance, few literatures have documented such injuries in an individual patient. The aim of this study is to validate the feasibility of damage control orthopedics (DCO).Method:A 15-years-old girl, involved in high-energy road traffic accident presented with hemodynamic instability. The pelvis was unstable with deformity in the right upper and lower extremities. Significant lacerations over forehead, right forearm and thigh present. Her radiographs proved the unstable pelvis fracture[A], multiple fractures of right lower limb with floating knee injury associated with PCL avulsion fracture[B-E], compound right ulna fracture[F], cerebral concussion, intra-abdominal injury and multiple lacerations establishing the distinctive of polytrauma.Results:The algorithm of DCO was resolute as treatment. Initial procedures of pelvic external fixation, right calcaneal traction, exploratory laparotomy, wound debridement and right long arm back-slab were done. CT pelvis and right knee performed after achieving initial fracture and hemodynamic stability. Internal fixations were applied after a period of time. The patient recovered after the DCO guided management with restoration of limb functional, and the quality of life greatly improved.Discussions:The DCO emphasizes the need to avoid further damage by the “second hit” which may originate from surgical procedures and focus on advanced life-saving supports.1 Our surgical team followed the principles of debridement and removal of the infection factors first, carried out definite surgery during the stable period. In addition to supply of the blood volume and protein, the nutritional support was emphasized.Conclusion:The DCO plays a pivotal role in the management strategies of complex pelvic ring injuries and floating knee with functional good outcome.

Progress in treatment of obsolete pelvic fracture

Severe pelvic fractures are often accompanied with injuries to abdominal and pelvic organs and nerves and vessels as well. Timely operations for pelvic fractures may be delayed due to urgent management of serious and life-threatening injuries, rendering the fractures obsolete. Patients with severe obsolete pelvic fracture often sustain severe pain, unstable pelvis, neurovascular injuries and organ dysfunction associated with pelvic malunion and malalignment which can only be treated by surgery. This paper reviews the literature and summarizes clinical manifestations of the fracture, indications for surgery, surgical treatment algorithms and difficulties encountered during operation, with an aim to provide useful information for management of obsolete pelvic fractures. Key words: Pelvis; Old fractures; Fracture, nonunion; Deformity

BIOMECHANICAL ANALYSIS OF DIFFERENT SURGICAL STRATEGIES FOR THE TREATMENT OF ROTATIONALLY UNSTABLE PELVIC FRACTURE USING FINITE ELEMENT METHOD

A rotationally unstable pelvic fracture can lead to loss of function and limit moving ability. Immediate fracture fixation is needed for patients with the pelvic fractures. However, it may be difficult to evaluate different surgical strategies for the fracture treatments due to variations in patients’ anatomies and surgical techniques. Thus, the purpose of the present study was to analyze the biomechanical performances of the intact, injured, and treated pelvises based on different physiological movements of the spine using finite element method. Three-dimensional musculoskeletal finite element models of the spine-pelvis-femur complex were developed. The intact pelvis, the rotationally unstable pelvis, and six types of pelvic fixation techniques were analyzed. Additionally, seven types of physiological movements of the spine were also considered. The results showed that the posterior iliosacral screws combined with lower and anterior plate (PIS-LAP) had good fixation stability, lower plate stress, and lower pelvic stress. However, the PIS-LAP increased the stress of the posterior iliosacral screws. The right lateral bending, left lateral bending, and flexion significantly affect all the biomechanical performances compared to the other physiological movements of the spine. The present study can provide engineers and surgeons with the understanding of the biomechanics of various fixation techniques during different physiological movements for the treatment of rotationally unstable pelvic fractures.

ACTES 2018 - Abstracts Book

Introduction: although the term “polytrauma” has been in use for decades, no generally accepted definition exists. Our definition has been until 2010: a combination of injuries where one, or the combination where one, or the combination of injuries himself is directly life threatening, in detail is meant: injury to two body cavities, or injury to one cavity committed by two long bone fractures, where spine and unstable pelvis has counted similarly as an injury to a cavity organ.&#x0D; Since 2013 a new definition has been established, the so-called Berlin definition.&#x0D; "A polytrauma means significant injuries of three or more points (AIS) in two or more different anatomic AIS regions in conjunction with one or more additional variables from 5 physiologic parameters: Hypotension (SBP - Systolic Blood Pressure &lt;= 90 mm Hg); Level of consciousness (GCS - Glasgow Coma Scale) ≤ 8; Acidosis (BE - Base Excess ≤ - 5.0); Coagulopathy (INR - International Normalized Ratio ≥ 1.4; PTT - Partial Thromboplastin Time ≥ 40 seconds, and Age ≥ 70 years).&#x0D; This definition fits the reality perfectly.&#x0D; The role of the surgeon in the trauma team is essential. It should provide multidisciplinary care to reduce diagnostic time and optimize therapeutic procedures.&#x0D; As Medicine adapts to the 21st century, new specialties arise. In the management of trauma, two models have been opposed in the past: on one side, a Trauma Surgeon based system, with specialists fully devoted to trauma care, often able to fix skeletal trauma too; on the other hand, blended systems with General Surgeons dealing with both elective and emergency surgery and trauma patients.&#x0D; The evolution of technology, of the epidemiology of trauma, and of the trauma systems and networks entailed the emerging of the concept of Acute Care Surgery. In the vast majority of Countries, this new specialist seems to better fit with the needs of both patients and health organization.&#x0D; Who is the Acute Care Surgeon? What is his minimal educational and technical background? How can interact with the other medical specialists playing around a trauma patient?

325. Model: Pelvic muscle pressure is the missing link in pregnancy hypertension

Hypothesis Placental ischemia/hypoxia is NOT the major initiating event in the pathogenesis of preeclampsia. It is pelvic muscle pressure. Methods During my Winston Churchill Memorial Trust traveling fellowship to explore how to prevent trauma to pelvic floor muscles during birth, I conducted a review of the literature published between 1990 and 2017 investigating classification, assessment, and (physiotherapeutic) treatment of pelvic dysfunction and muscle physiology and biomechanics during pregnancy and postpartum. Expert opinions with biomedical engineers and muscle physiologists were also sought via interviews. Findings Studies revealed a conceptual model where muscles in the pelvic area become chronically tense (a high tone pelvis) because of multifactorial insults antepartum and postpartum. Pressurizing the pelvis and culminating in raised blood pressure. A triad of interrelated insults were identified which are mothers being encouraged to do Kegels with no relaxation component. The growing number of mothers with emotional stress disorders which manifest physically as tense muscles especially those in the pelvic region. And thirdly postural adaptations of pregnancy such as lumbar lordosis and anterior pelvic tilt being amplified by mothers poor lifestyle practices such as prolonged sitting, wearing heels and inadequate breathing causing shortened piriformis, quadriceps and other pelvic region muscles. Creating an unstable pelvis and compensatory spasm of antagonist muscles such as the pelvic floor to try and balance the pelvis.These tight or spasmed pelvic muscles are not just dysfunctional, but theoretically left unused their blood vessels become stiff resisting blood flow and causing volume overload at the heart, with a compensatory heart rate and blood pressure increase. Conclusion We are dealing with a pelvic pressure issue, not just a blood pressure one. A silent epidemic of tight pelvic muscles should be considered as a major initiating event in the pathogenesis of pregnancy hypertension in a significant number of mothers. Further studies are needed in this exciting area.