Pelvic fracture nerve injury, seizing the treatment opportunity is the key

There are many cases of pelvic fractures and nerve damage in accidents. In this case, seizing the opportunity for treatment is the key, and then necessary surgical treatment should be performed according to the severity of the disease. The main fixation methods are external fixators, pubic reconstruction plates, hollow lag screws, etc.

1. Timing of surgery: It is best to perform the surgery within 7 days after injury and no later than 14 days. Otherwise, the difficulty of reduction will be greatly increased, and the incidence of malunion and nonunion will also increase significantly.

2. Choose the treatment method according to the fracture classification: Type A pelvic fractures in the AO classification are stable fractures and are generally treated conservatively, with bed rest for 4-6 weeks and early walking exercises; Type B fractures are anterior ring injuries and only require anterior fixation; Type C fractures are posterior ring or anterior-posterior combined injuries, requiring anterior-posterior fixation of the pelvic ring.

3. Indications for surgery : (1) Failure of closed reduction; (2) Residual displacement after external fixation; (3) Symphysis pubis separation greater than 2.5 cm or symphysis pubis locking; (4) Vertically unstable fracture; (5)

Combined with acetabular fracture; (6) severe pelvic rotation deformity leading to lower limb rotation dysfunction; (7) posterior pelvic ring structure injury and displacement >1cm, or pubic displacement combined with posterior pelvic instability, shortening of the affected limb >1.5cm; (8) open posterior injury without perineal contamination. (9) Pubic ramus fracture with femoral nerve and vascular injury, (10) open fracture

4. Surgical method:

(1) Anterior fixation: used to fix anterior ring instability, commonly used for pubic symphysis separation and pubic ramus fracture. Surgical indications are: a. pubic symphysis separation greater than 2.5 cm b. pubic symphysis locking c. pubic ramus fracture combined with femoral nerve and vascular injury d. open pubic ramus fracture e. combined with posterior pelvic instability

The main fixation methods are external fixator, pubic reconstruction plate, hollow lag screw

(2) Posterior fixation: used to fix posterior ring instability, commonly used for sacroiliac joint separation, sacral fracture, etc. Indications for surgery are: a. vertically unstable fractures, b. posterior pelvic ring structure injury displacement > 1 cm, c. open posterior injury without perineal contamination

d. Combined acetabular fracture.

The main fixation methods are: C-clamp, presacral plate fixation; postsacral sacral bolt, sacral plate, sacral lag screw fixation

5. Surgical approach and fixation method:

(1) External fixator: front fixation

In most cases, external fixators are used for temporary fixation of unstable pelvic fractures, or combined with other fixation methods to fix severely unstable pelvic fractures. They are not used as a routine final fixation option. The commonly used fixation method is the double nail method, that is, two threaded nails are driven into the iliac spines on both sides; when the condition is critical, one threaded nail can also be driven into each side. If long-term fixation is considered, a threaded nail can be driven above the anterior inferior iliac spine (upper edge of the acetabulum). Before placing the nails, you can use a bed sheet or something similar to hold the pelvis tightly.