Pelvic Fracture Stabilization

The approach depends on the fracture pattern, patient stability, and associated injuries:

1. Before Procedure Evaluation:
   
   • Diagnosis:
     
     • Physical exam: Pelvic tenderness, deformity, or instability (e.g., springing test).
     • X-rays (AP, inlet, outlet views) and CT scan assess fracture pattern and displacement.
     • Blood tests evaluate hemoglobin (for bleeding) and organ function.
     • FAST ultrasound or CT identifies intra-abdominal bleeding or organ injury.
   • IV fluids, blood transfusions, and pain management stabilize the patient.
   • Urologic assessment (e.g., retrograde urethrogram) rules out bladder/urethral injury.
2. Stabilization Techniques:
   
   • Non-Surgical (Conservative) Management:
     
     • For stable fractures with minimal displacement (e.g., isolated pubic ramus fractures).
     • Bed rest (2–6 weeks), pain control, and limited weight-bearing with crutches.
     • Pelvic binder or sling may be used to reduce displacement and bleeding in the acute phase.
   • Emergency Stabilization (for Hemodynamic Instability):
     
     • Pelvic Binder/Sheet:
       
       • Applied at the level of the greater trochanters to close the pelvic ring and tamponade bleeding.
       • Used in the field or ER as a temporary measure.
     • External Fixation:
       
       • Performed under general anesthesia, lasting 30–60 minutes.
       • Pins are inserted into the iliac crests, connected by an external frame to stabilize the pelvis.
       • Controls bleeding (e.g., venous, cancellous bone) and stabilizes the pelvis within hours of injury.
     • Angiographic Embolization:
       
       • For arterial bleeding (e.g., internal iliac artery), performed by an interventional radiologist.
       • Often combined with external fixation for unstable patients.
   • Definitive Surgical Stabilization:
     
     • Open Reduction and Internal Fixation (ORIF):
       
       • Performed 3–7 days after injury, once the patient is stable, lasting 2–4 hours.
       • Incisions over the pelvis (e.g., anterior Pfannenstiel approach, posterior sacroiliac approach).
       • Fractures are realigned, and plates/screws are used to fix the pelvic ring (e.g., symphysis pubis, sacroiliac joint).
       • Sacral fractures may require sacroiliac screws or plates.
     • Percutaneous Fixation:
       
       • Minimally invasive, using fluoroscopy to place screws (e.g., iliosacral screws) through small incisions.
       • Suitable for posterior pelvic ring injuries with minimal soft tissue damage.
     • Acetabular Fracture Fixation:
       
       • ORIF of the acetabulum restores the hip joint surface, often using specialized plates/screws.
       • Takes 3–5 hours; may require a separate procedure if the pelvic ring is also involved.
3. After Surgery:
   
   • Patients are monitored in the ward or ICU (if unstable) for 3–7 days.
   • Pain is managed with analgesics (e.g., morphine, NSAIDs); antibiotics prevent infection.
   • Weight-bearing status: Non-weight-bearing or partial weight-bearing with crutches for 6–12 weeks.
   • Follow-up X-rays assess healing and alignment.