Treatment of pelvic fractures: choosing the right method is crucial

At present, trapezoidal compression stent reduction, internal iliac artery ligation, external fixator therapy and other methods are commonly used methods for treating pelvic fractures, but the indications are different. Patients should choose the most suitable treatment method according to their actual situation.

(A) Trapezoidal compression brace reduction of pelvic fracture . Pelvic fractures or fracture-dislocations rarely require open reduction and internal fixation. Generally, good results can be achieved through bed rest, pelvic cuffs, braces, and bone traction. In order to reduce bed rest time and promote early ambulation, some people have advocated the use of external fixators in recent years.

Indications: Unilateral or bilateral fractures with sacroiliac joint dislocation and pubic symphysis separation.

For sacroiliac joint dislocation exceeding 1 cm, lower limb bone traction can be performed first, and AO screw fixation can be used after satisfactory reduction.

(ii) Internal iliac artery ligation?

Indications: Severe bleeding from pelvic fracture causing hemorrhagic shock, with the amount of bleeding reaching 2000-4000 or more. Despite rapid blood transfusion and fluid infusion, the patient's blood pressure cannot be maintained.

Anesthesia: epidural block or endotracheal intubation with combined inhalation and intravenous anesthesia.

Body position: supine, head low and feet high.

Methods: transperitoneal internal iliac artery ligation, extraperitoneal internal iliac artery ligation.

(III) Treatment of pelvic fracture with external fixator?

Advantages: While rescuing shock and multiple injuries, external fixators are used to stabilize fractures and control bleeding, and fractures and multiple injuries can be treated simultaneously.

Indications: 1. Anteroposterior pelvic compression type (such as bilateral pubic ramus fracture, pubic symphysis separation), lateral compression type (such as ilium fracture, hemipelvic dislocation, pubic symphysis overlap) and vertical shear fracture (such as unilateral sacroiliac joint dislocation).

2. Unstable pelvic fractures accompanied by open fractures of the limbs and multiple injuries.

3. Pelvic fracture and dislocation combined with visceral injury, multiple fractures and shock.

Contraindications: bilateral vertical shear-type pelvic fractures (such as bilateral sacroiliac joint dislocation) and pelvic comminuted fractures.