Fractures, Bone ; diagnosis ; diagnostic imaging ; surgery ; therapy ; Humans ; Pelvic Bones ; diagnostic imaging ; injuries ; surgery ; Radiography

Fracture Fixation ; methods ; trends ; Fractures, Bone ; surgery ; Humans ; Pelvic Bones ; injuries ; surgery

Fractures, Bone ; complications ; diagnosis ; surgery ; therapy ; Humans ; Pelvic Bones ; injuries ; surgery ; Time Factors

The management of multiple complicated injured patients remains a great challenge despite advance- ments in modern medical care. We present a rare case of bilateral unstable pelvic fractures associated with bilateral segmental femoral shaft fractures.We have proposed a mechanism of such complex injury pattern and discussed the plan of management. We believe that a timely and aggressive surgical intervention to fix all the major fractures soon after medically stabilizing the patient helped our patient to overcome these serious and lethal injuries. It is necessary to establish an optimal protocol for management of such complex fractures by conducting prospective and multicentric studies in the future.
Adult ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Humans ; Pelvic Bones ; diagnostic imaging ; injuries

Pelvic fractures are serious injuries. Death within 24 hours is most often a result of acute blood loss. The emergency management of these patients is challenging and controversial. The key issues in its management are identifying the site(s) of hemorrhage and then controlling the bleeding. Management of hemodynamically unstable patients with pelvic fracture requires a multidisci- plinary team. The issues addressed in this management algorithm are diagnostic evaluation, damage control resuscitation, indications for noninvasive pelvic stabilization, preperitoneal pelvic packing and the critical decisions concerning surgical options and angiography. This review article focuses on the recent body of know- ledge on those determinations.
Angiography ; Embolization, Therapeutic ; Fractures, Bone ; surgery ; Hemorrhage ; Humans ; Pelvic Bones ; injuries

Acetabulum ; injuries ; surgery ; Adult ; Female ; Fractures, Bone ; surgery ; Hip Injuries ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; surgery ; Spinal Fractures ; surgery ; Young Adult

OBJECTIVETo explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture.

METHODSFrom June 2000 to August 2010, 72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years (averaged 35.2 years). The time from injury to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy; 25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence, impotence and urethrostenosis were evaluated.

RESULTSAll patients were followed up for 5 to 10 years (mean 7.7 years). Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were significantly higher than rupture anastomosis on the stage I and early realignment (P < 0.05); while incidence in patients treated by catheterization was significantly lower than other groups (P < 0.05).

CONCLUSIONFor patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.

Adult ; Female ; Fractures, Bone ; complications ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Urethra ; injuries ; surgery

An internal-external fixator for stabilization in three cases with unstable pelvic fractures were reported. Compared with external fixation, the internal-external fixator, which is placed in the subcutaneous layer, decreased the risk of pin-track infection, pin site pain, and bowel obstruction; meanwhile, it had the advantage of external fixation: it was easy to apply, controlled damage, and resulted in minimal injury.
Adolescent ; Adult ; Aged ; External Fixators ; Female ; Fracture Fixation ; methods ; Fractures, Bone ; surgery ; Humans ; Internal Fixators ; Male ; Pelvic Bones ; injuries ; surgery

Angiography ; Balloon Occlusion ; Embolization, Therapeutic ; Fractures, Bone ; surgery ; Hemostasis, Surgical ; methods ; Humans ; Iliac Artery ; surgery ; Ligation ; Pelvic Bones ; injuries

BACKGROUND: The Stoppa (intrapelvic) approach has been introduced for the treatment of pelvic-acetabular fractures; it allows easy exposure of the pelvic brim, where the bone quality is optimal for screw fixation. The purpose of our study was to investigate the surgical outcomes of unstable pelvic ring injuries treated using the Stoppa approach for stable anterior ring fixation. METHODS: We analyzed 22 cases of unstable pelvic ring injury treated with plate fixation of the anterior ring with the Stoppa approach. We excluded cases of nondisplaced rami fracture, simple symphyseal diastasis, and parasymphyseal fractures, which can be easily treated with other techniques. The average age of the study patients was 41 years (range, 23 to 61 years). There were 10 males and 12 females. According to the Young and Burgess classification, there were 12 lateral compression, 4 anteroposterior compression, and 6 vertical shear fracture patterns. The fracture location on the anterior ring was near the iliopectineal eminence in all cases and exposure of the pelvic brim was required for plate fixation. All patients were placed in the supine position. For anterior plate fixation, all screws were applied to the anterior ramus distally and directed above the hip joint proximally. Radiologic outcomes were assessed by union time and quality of reduction by Matta method. The Merle d'Aubigne-Postel score was used to evaluate the functional results. RESULTS: The average radiologic follow-up period was 16 months (range, 10 to 51 months). All fractures united at an average of 3.5 months (range, 3 to 5 months). According to the Matta method, the quality of reduction was classified as follows: 16 anatomical (73%) and 6 nearly anatomical (27%) reductions. There were no cases of screw or implant loosening before bone healing. The functional results were classified as 7 excellent (32%), 12 good (55%), and 3 fair (13%) by the Merle d'Aubigne-Postel score. There were no wound complications, neurovascular injuries, or other complications related to the surgical approach. CONCLUSIONS: Stable anterior ring fixation placed via the Stoppa approach can result in excellent reduction and stable screw fixation with a low complication rate.
Adult ; Female ; Fracture Fixation, Internal/adverse effects/*methods ; Hip Fractures/*surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones/injuries/*surgery ; Pelvis/injuries/*surgery ; Retrospective Studies ; Young Adult