Der Unfallchirurg
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Unstable pelvic girdle injury combined with severe pelvis related haemorrhage has a high mortality rate. This prognosis can be improved by using the C-clamp according to Ganz. ⋯ Due to the limited number of patients, trauma centres have the most experience with this technique. In this contribution, we present our standardised application technique, which allows the use of the procedure through well defined clinically recognisable orientation points in the emergency room.
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The Trans Iliacal Internal Fixator (TIFI) is a minimally invasive technique for the stabilization of sacro-iliac joint ruptures and fractures lateral to the sacral ala or through the sacral foramen. In this study, 7.0 mm pedicle screws of the Universal-Spine-System (USS, Synthes) were inserted 1-2 cm on the cranial side of the posterior superior iliac spine and parallel to the superior gluteal line. The connecting bar was inserted subfascially and fixed with the locking head pedicle screws to form an fixed-angle construction. ⋯ Early findings show that the TIFI is well suited to stabilization of sacro-iliac joint ruptures and fractures of the lateral sacrum. Closed reduction and minimally invasive insertion technique are possible. The implant leads to sufficient biomechanical stability but there is a very low intraoperative risk of neuro-vascular lesion.
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The application of autogenous bone grafts represents the golden standard for reconstruction of the load-bearing anterior column in the thoracolumbar spine. However, the osseous integration of the implanted grafts is demanding and delayed union or pseudarthrosis may occur. There are no standardized data available yet indicating the further course in such cases. ⋯ Despite the incomplete integration of the bone grafts, the further course without surgical intervention revealed no clinical or radiological evidence of a concomitant implant loosening or a relevant secondary loss of correction. Similar to the open technique, endoscopic reconstruction of the anterior column with autogenous bone grafts may lead to disadvantageous results concerning the integration and healing of the applied bone grafts. Decision making in such cases depends on the individual clinical and radiological findings (i.e., evidence of implant loosening and concomitant loss of correction).
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Pelvic fracture, especially in combination with multiple trauma, can still lead to ife-threatening situations. Only clear inclusion criteria and decisions can ensure survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-orientated management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. ⋯ This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.
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Two thirds of the fractures of the scapula refer to its body, one third to its neck, and one forth to the glenoid. They are indicative of high-energy blunt trauma. Traffic injuries are their main cause. ⋯ The anterior approach of Neer and the dorsolateral approach of Brodsky are very suitable. As a basic principle dislocated or unstable fractures of the scapular processes and of the glenoid should be treated by internal fixation, since their functional result may be less than fair if they are treated conservatively. Most other fractures heal uneventful under a conservative regimen.