Pelvic fractures

Part 2. Contemporary indications and techniques for definitive surgical management

Joshua R. Langford, Andrew R. Burgess, Frank A. Liporace, George J. Haidukewych

Research output: Contribution to journalArticle

Abstract

Once the patient with pelvic fracture is resuscitated and stabilized, definitive surgical management and anatomic restoration of the pelvic ring become the goal. Understanding injury pattern by stress examination with the patient under anesthesia helps elucidate the instability. Early fixation of the unstable pelvis is important for mobilization, pain control, and prevention of chronic instability or deformity. Current pelvic fracture management employs a substantial amount of percutaneous reduction and fixation, with less emphasis placed on pelvic reconstruction proceeding from posterior to anterior, and most reduction and fixation of unstable pelvic fractures done with the patient supine. Compared with control subjects with acetabular fracture or pelvic fracture alone, patients with combined injury have a significantly higher Injury Severity Score, lower systolic blood pressure, and higher mortality rates; they are also transfused more packed red blood cells. Even with anatomic restoration of the pelvis, long-term outcomes after severe pelvic trauma are below population norms. The most common chronic problems relate to sexual dysfunction and pain. Regardless of fracture type, neurologic injury is a universal harbinger of poor outcome.

Original languageEnglish (US)
Pages (from-to)458-468
Number of pages11
JournalThe Journal of the American Academy of Orthopaedic Surgeons
Volume21
Issue number8
DOIs
StatePublished - Aug 2013
Externally publishedYes

Fingerprint

Pelvis
Wounds and Injuries
Blood Pressure
Nervous System Trauma
Pain
Injury Severity Score
Anesthesia
Erythrocytes
Mortality
Population

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Pelvic fractures : Part 2. Contemporary indications and techniques for definitive surgical management. / Langford, Joshua R.; Burgess, Andrew R.; Liporace, Frank A.; Haidukewych, George J.

In: The Journal of the American Academy of Orthopaedic Surgeons, Vol. 21, No. 8, 08.2013, p. 458-468.

Research output: Contribution to journalArticle

Langford, Joshua R. ; Burgess, Andrew R. ; Liporace, Frank A. ; Haidukewych, George J. / Pelvic fractures : Part 2. Contemporary indications and techniques for definitive surgical management. In: The Journal of the American Academy of Orthopaedic Surgeons. 2013 ; Vol. 21, No. 8. pp. 458-468.
@article{60a05dd28af142f0ba4f7ae60bb88872,
title = "Pelvic fractures: Part 2. Contemporary indications and techniques for definitive surgical management",
abstract = "Once the patient with pelvic fracture is resuscitated and stabilized, definitive surgical management and anatomic restoration of the pelvic ring become the goal. Understanding injury pattern by stress examination with the patient under anesthesia helps elucidate the instability. Early fixation of the unstable pelvis is important for mobilization, pain control, and prevention of chronic instability or deformity. Current pelvic fracture management employs a substantial amount of percutaneous reduction and fixation, with less emphasis placed on pelvic reconstruction proceeding from posterior to anterior, and most reduction and fixation of unstable pelvic fractures done with the patient supine. Compared with control subjects with acetabular fracture or pelvic fracture alone, patients with combined injury have a significantly higher Injury Severity Score, lower systolic blood pressure, and higher mortality rates; they are also transfused more packed red blood cells. Even with anatomic restoration of the pelvis, long-term outcomes after severe pelvic trauma are below population norms. The most common chronic problems relate to sexual dysfunction and pain. Regardless of fracture type, neurologic injury is a universal harbinger of poor outcome.",
author = "Langford, {Joshua R.} and Burgess, {Andrew R.} and Liporace, {Frank A.} and Haidukewych, {George J.}",
year = "2013",
month = "8",
doi = "10.5435/JAAOS-21-08-458",
language = "English (US)",
volume = "21",
pages = "458--468",
journal = "The Journal of the American Academy of Orthopaedic Surgeons",
issn = "1067-151X",
publisher = "American Association of Orthopaedic Surgeons",
number = "8",

}

TY - JOUR

T1 - Pelvic fractures

T2 - Part 2. Contemporary indications and techniques for definitive surgical management

AU - Langford, Joshua R.

AU - Burgess, Andrew R.

AU - Liporace, Frank A.

AU - Haidukewych, George J.

PY - 2013/8

Y1 - 2013/8

N2 - Once the patient with pelvic fracture is resuscitated and stabilized, definitive surgical management and anatomic restoration of the pelvic ring become the goal. Understanding injury pattern by stress examination with the patient under anesthesia helps elucidate the instability. Early fixation of the unstable pelvis is important for mobilization, pain control, and prevention of chronic instability or deformity. Current pelvic fracture management employs a substantial amount of percutaneous reduction and fixation, with less emphasis placed on pelvic reconstruction proceeding from posterior to anterior, and most reduction and fixation of unstable pelvic fractures done with the patient supine. Compared with control subjects with acetabular fracture or pelvic fracture alone, patients with combined injury have a significantly higher Injury Severity Score, lower systolic blood pressure, and higher mortality rates; they are also transfused more packed red blood cells. Even with anatomic restoration of the pelvis, long-term outcomes after severe pelvic trauma are below population norms. The most common chronic problems relate to sexual dysfunction and pain. Regardless of fracture type, neurologic injury is a universal harbinger of poor outcome.

AB - Once the patient with pelvic fracture is resuscitated and stabilized, definitive surgical management and anatomic restoration of the pelvic ring become the goal. Understanding injury pattern by stress examination with the patient under anesthesia helps elucidate the instability. Early fixation of the unstable pelvis is important for mobilization, pain control, and prevention of chronic instability or deformity. Current pelvic fracture management employs a substantial amount of percutaneous reduction and fixation, with less emphasis placed on pelvic reconstruction proceeding from posterior to anterior, and most reduction and fixation of unstable pelvic fractures done with the patient supine. Compared with control subjects with acetabular fracture or pelvic fracture alone, patients with combined injury have a significantly higher Injury Severity Score, lower systolic blood pressure, and higher mortality rates; they are also transfused more packed red blood cells. Even with anatomic restoration of the pelvis, long-term outcomes after severe pelvic trauma are below population norms. The most common chronic problems relate to sexual dysfunction and pain. Regardless of fracture type, neurologic injury is a universal harbinger of poor outcome.

UR - http://www.scopus.com/inward/record.url?scp=84882397799&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84882397799&partnerID=8YFLogxK

U2 - 10.5435/JAAOS-21-08-458

DO - 10.5435/JAAOS-21-08-458

M3 - Article

VL - 21

SP - 458

EP - 468

JO - The Journal of the American Academy of Orthopaedic Surgeons

JF - The Journal of the American Academy of Orthopaedic Surgeons

SN - 1067-151X

IS - 8

ER -