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Pubis symphysis fusion: Patient characteristics and outcomes
172 [O37] Pubis symphysis fusion: Patient characteristics and outcomes P.V. Giannoudis 1,∗ , N.K. Kanakaris 1 , M.D. Bircher 2 1 2
Leeds Teaching Hospitals, UK St. George’s Hospital, London, UK
Purpose: Aim of this study was to identify the different patient characteristics and outcome parameters related with fusion of the pubic symphysis (PSF). Methods: Data of patients who underwent a PSF at both institutions over a period of 5 years have been prospectively collected and analysed. Demographics, causative factors of PSF, initial treatment, in-hospital and intra-operative details, together with union/non-union rates, time to union, complication rates and EuroQol (EQ-5D, EQ-VAS) before and after injury all been accumulated. Chi square test was used to analyse the results. Results: Between 2000 and 2006, 30 patients (16 females) have been submitted to a PSF. The median age of males vs. females was 38.5 vs. 32 years (p < 0.001). The indication for 16 of the PFS (53%) was post-partum persistent pelvic instability and pain, and for the rest was trauma (road traffic accidents (5), falls (7), and sports injuries (2)). Nine patients were smokers and four alcohol abusers. The median time from injury to PSF was 2 months (range 2 weeks to 4.5 years). Single or double plate fixation with iliac crest tricortical autograft was used in the majority of cases (23 vs. 7). The median follow-up period was 18 months (range 12—60). Ninety-three per cent of the PSF patients united at a median time of 5.3 months. Early post-operative complications have been documented in 3 cases (superficial infection, hematuria), and late complications, non-union 2 cases, anterior pelvic pain in 6. One-third of these PSF patients did not return to their work. Pre- and post-PSF EQ-5D questionnaire and VAS scores have showed satisfactory results in 23 cases (76.7%). Conclusion: In cases of anterior pelvic instability and pain caused from postpartum and post traumatic pubic symphysis rupture, fusion of the pubic symphysis offers satisfactory results as seen in this series of patients. Keywords: Pubic symphysis; Fusion doi:10.1016/j.injury.2007.11.327 [O38] The application of the pelvic C-clamp in polytrauma patients with haemodynamically unstable pelvic ring fractures
Abstract so help to improve the clinical outcome of the polytrauma patients. Problem: Is the application of the pelvic C-clamp, guided only by clinical landmarks and without radiological feedback e.g. by a C-arm, sufficiently safe? Material and methods: In a period of 6 years 26 polytrauma patients (9 females, 17 males) with an average age of 47 years (16 up to 81 years) were initial stabilized with a pelvic C-clamp because of an unstable pelvic ring fracture (one type B, 25 type C-fractures). The average ISS was 36 (18 up to 75), 7 patients had complex pelvic injuries. Indications for the application were haemodynamical instability, initial haemoglobin of 7 mg/dl and a pelvic bleeding source. For emergency clamp application no C-arm was used but the result was controlled by a following polytrauma CT-scan and radiography. We investigated the fracture reduction, placement of the pins and secondary loosening and pin dislocation. Results: The average time between clamp application and definitive operative fracture stabilization was seven days (4 up to 10 days). The mortality rate was 19% (5 from 26). In 23 cases (88%) anatomical fracture reduction was evident, in one case (4%) no sufficient fracture compression was possible despite of regular pin placement, in two (8%) cases over-compression occurred because of pin displacement. In 19 patients (72%) pins were placed regularly, in 4 patients (16%) a coarse dislocation (>40 mm) with no need of replacement was visible. A revision of misplaced pins was necessary in three cases (12%) because of pin perforation into the pelvis or the hip joint. Summary: The application of the pelvic C-clamp as part of the trauma management is a valid treatment in the therapy of patients with unstable pelvic ring fractures and pelvic bleeding source. With a landmark-guided pin placement and no radiological guidance a fracture reduction can be achieved. Conclusion: The pelvic C-clamp is a safe method of the emergency stabilization of haemodynamically unstable pelvic ring fractures and can prevent secondary complications. Keywords: unstable
C-clamp; Pelvic fracture; Haemodynamically
doi:10.1016/j.injury.2007.11.328 [O39] A comparison of standard vs. 3D fluoroscopy in placing a supra-acetabular lag-screw: A pre-clinical study G. Pereira ∗ , D. Griffin, M. Blakemore
J. B¨ ohme ∗ , S. Klima, A. Hoech, A. Tiemann, C.H. Josten
Warwick Orthopaedics, UHCW, UK
Klinik f¨ ur Unfall-, Wiederherstellungs- und Plastische Chirurgie Universit¨ atsklinikum Leipzig, Germany
WITHDRAWN PAPER
Introduction: Unstable pelvic ring fractures are often associated with severe bleeding complications, caused by ruptured presacral venous plexus and fracture bleeding in more than 80%. Emergency stabilization with a pelvic Cclamp enables fracture compression and reduction of the pelvic volume. Because of ease of application the pelvic Cclamp can be integrated into trauma initial management and
doi:10.1016/j.injury.2007.11.329
Leeds Teaching Hospitals, UK St. George’s Hospital, London, UK
Purpose: Aim of this study was to identify the different patient characteristics and outcome parameters related with fusion of the pubic symphysis (PSF). Methods: Data of patients who underwent a PSF at both institutions over a period of 5 years have been prospectively collected and analysed. Demographics, causative factors of PSF, initial treatment, in-hospital and intra-operative details, together with union/non-union rates, time to union, complication rates and EuroQol (EQ-5D, EQ-VAS) before and after injury all been accumulated. Chi square test was used to analyse the results. Results: Between 2000 and 2006, 30 patients (16 females) have been submitted to a PSF. The median age of males vs. females was 38.5 vs. 32 years (p < 0.001). The indication for 16 of the PFS (53%) was post-partum persistent pelvic instability and pain, and for the rest was trauma (road traffic accidents (5), falls (7), and sports injuries (2)). Nine patients were smokers and four alcohol abusers. The median time from injury to PSF was 2 months (range 2 weeks to 4.5 years). Single or double plate fixation with iliac crest tricortical autograft was used in the majority of cases (23 vs. 7). The median follow-up period was 18 months (range 12—60). Ninety-three per cent of the PSF patients united at a median time of 5.3 months. Early post-operative complications have been documented in 3 cases (superficial infection, hematuria), and late complications, non-union 2 cases, anterior pelvic pain in 6. One-third of these PSF patients did not return to their work. Pre- and post-PSF EQ-5D questionnaire and VAS scores have showed satisfactory results in 23 cases (76.7%). Conclusion: In cases of anterior pelvic instability and pain caused from postpartum and post traumatic pubic symphysis rupture, fusion of the pubic symphysis offers satisfactory results as seen in this series of patients. Keywords: Pubic symphysis; Fusion doi:10.1016/j.injury.2007.11.327 [O38] The application of the pelvic C-clamp in polytrauma patients with haemodynamically unstable pelvic ring fractures
Abstract so help to improve the clinical outcome of the polytrauma patients. Problem: Is the application of the pelvic C-clamp, guided only by clinical landmarks and without radiological feedback e.g. by a C-arm, sufficiently safe? Material and methods: In a period of 6 years 26 polytrauma patients (9 females, 17 males) with an average age of 47 years (16 up to 81 years) were initial stabilized with a pelvic C-clamp because of an unstable pelvic ring fracture (one type B, 25 type C-fractures). The average ISS was 36 (18 up to 75), 7 patients had complex pelvic injuries. Indications for the application were haemodynamical instability, initial haemoglobin of 7 mg/dl and a pelvic bleeding source. For emergency clamp application no C-arm was used but the result was controlled by a following polytrauma CT-scan and radiography. We investigated the fracture reduction, placement of the pins and secondary loosening and pin dislocation. Results: The average time between clamp application and definitive operative fracture stabilization was seven days (4 up to 10 days). The mortality rate was 19% (5 from 26). In 23 cases (88%) anatomical fracture reduction was evident, in one case (4%) no sufficient fracture compression was possible despite of regular pin placement, in two (8%) cases over-compression occurred because of pin displacement. In 19 patients (72%) pins were placed regularly, in 4 patients (16%) a coarse dislocation (>40 mm) with no need of replacement was visible. A revision of misplaced pins was necessary in three cases (12%) because of pin perforation into the pelvis or the hip joint. Summary: The application of the pelvic C-clamp as part of the trauma management is a valid treatment in the therapy of patients with unstable pelvic ring fractures and pelvic bleeding source. With a landmark-guided pin placement and no radiological guidance a fracture reduction can be achieved. Conclusion: The pelvic C-clamp is a safe method of the emergency stabilization of haemodynamically unstable pelvic ring fractures and can prevent secondary complications. Keywords: unstable
C-clamp; Pelvic fracture; Haemodynamically
doi:10.1016/j.injury.2007.11.328 [O39] A comparison of standard vs. 3D fluoroscopy in placing a supra-acetabular lag-screw: A pre-clinical study G. Pereira ∗ , D. Griffin, M. Blakemore
J. B¨ ohme ∗ , S. Klima, A. Hoech, A. Tiemann, C.H. Josten
Warwick Orthopaedics, UHCW, UK
Klinik f¨ ur Unfall-, Wiederherstellungs- und Plastische Chirurgie Universit¨ atsklinikum Leipzig, Germany
WITHDRAWN PAPER
Introduction: Unstable pelvic ring fractures are often associated with severe bleeding complications, caused by ruptured presacral venous plexus and fracture bleeding in more than 80%. Emergency stabilization with a pelvic Cclamp enables fracture compression and reduction of the pelvic volume. Because of ease of application the pelvic Cclamp can be integrated into trauma initial management and
doi:10.1016/j.injury.2007.11.329