The use of external fixators in the definitive stabilisation of the pelvis in polytrauma patients: Safety,efficacy and clinical outcomes |
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| Affiliation: | 1. Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK;2. NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA West Yorkshire, Leeds, UK;1. Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ, United States;2. Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States;3. Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States;1. Dept. of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans, LA, United States;2. Dept. of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States;3. Dept. of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, United States;4. Dept. of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States;5. Dept. of Orthopaedic Surgery, Duke University, Durham, NC, United States;6. Dept. of Statistics, North Carolina State University, Raleigh, NC, United States;7. Clinical Affairs, Bioventus LLC, Durham, NC, United States;1. Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea;2. Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea;1. University of Queensland, School of Medicine, Herston, Brisbane, Australia;2. Ipswich General Hospital, Chelmsford Ave, Ipswich, Queensland, Australia;1. Department of General Surgery, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada;2. Department of Pediatric Surgery, McGill University Health Centre, 1001 Décarie Boulevard, Montreal, Quebec, H4A 3JI, Canada |
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| Abstract: | ObjectivesTo analyse the complications and outcomes (functional/radiographic) of Pelvic External Fixators applied as part of the definitive fixation in polytrauma patients.DesignA single center retrospective chart review.SettingA level-1 trauma center.Patients and methodsWe reviewed all the polytrauma patients (ISS > 16) between 2007 and 2012 that had a PEF applied more than 30 days. Complications including infection, aseptic loosening, neurological injury, loss of reduction, non-union and mal-union were recorded. Pelvic asymmetry and Deformity Index (DI) were measured at the immediate postoperative radiographs and final follow-up. The functional outcome at final follow up was estimated using a scale previously reported by Chiou et al.Results59 patients with mean age of 38.4 (16 − 81) years and mean ISS score 28 (16- 66) were included. The PEFs were applied for mean duration of 56 (30–104) days. The average follow-up was 403 days. 22 injuries were type B and 37 type C (AO/OTA). The most common symptomatic complications were pin site infection in 11 (18.6%) and loosening in 5 (8.5%) cases. 44 (74.5%) patients had satisfactory functional outcome. The immediate post-operative and final asymmetry and DI were compared between the two pelvic injury groups (type B and C fractures). The difference in displacement progression was more for type C injuries (p = 0.034) but no correlation to the functional outcome was evident.ConclusionPEF can be used as definitive alternative stabilization method in specific situations at polytrauma setting. Radiological displacement occurred in both type B and C injuries but the clinical outcome was not correlated to this displacement. Complications related to PEF do not affect the final clinical outcome.Level of evidenceTherapeutic Level III. |
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| Keywords: | Pelvic external fixator Pelvic ring injuries Polytrauma |
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