вверх
отправить
поиск
админ
главная
|
 Отправлено Jeff Richmond 25 Сентябрь 2007, 22:43
Any advice would be appreciated:
40 ish female ejected from car. Unstable, DPL negative, went to angio and had her pelvic bleeds embolized after many units of blood. GCS 6, floating elbow, clavicle, bothbones, etc.
My standard approach to this pelvis would be posterior, reduce/lag/plate thecrest, reduce/plate the caudal extent on the posterior crest and 1-2 lags back to front. In this case, the crest comminution seems to make plating all the way to the ASIS useless, as the plate would be on free floating fragments. Would plating the posterior extent of the fracture to secure the reduction at the SI joint and 2 screws back to front be sufficient fixation? Would anyone do a perc reduction and perc back to front screws, and would that be sufficient if the SI joint could be reduced (although I don't see how this could be accurately reduced closed). Would an ilioninguinal with a pelvic brim plate and posterior column screws be a better approach, although reducing the SI would be more indirect and less accurate?
Thanks
Jeff Richmond
<
|
>
|
|
Ответить
|
Re: comminuted crescent fx
Chip Routt 25 Сентябрь 2007, 22:58
|
It's a comminuted iliac fracture involving the GS notch and all that
implies...use the lateral interval of an ilioinguinal, sequentially reduce,
and fix...if you want to, you can attach the dominant unstable fragment to
both the stable posterior iliac fragment and also to the anterolateral portion of the sacrum using plates...if you choose to anchor to both, the implants get congested on the iliac side of the SI joint so be precise with contouring and such applications...perhaps and based on the images shown, an iliosacral screw would only augment the construct if applied to the second sacral segment (but this is difficult to assess on the images shown). The crest components can be held securely with screws and/or peripheral plating.
Chip
|
[
Ответить ]
|
Re: comminuted crescent fx
Отправитель: Jeff Richmond 25 Сентябрь 2007, 22:58
|
Thanks. I probably didn't include enough images on the CT, but it didn't look to me like an SI screw would be of value except into S2, which I am not
comfortable placing. I will post finals if the neurosurgeons let me operate on her. ICPs still a problem.
Thanks
Jeff
|
[
Ответить ]
|
|
Re: comminuted crescent fx
Adam Starr 25 Сентябрь 2007, 23:00
|
Hi Jeff,
I always manage these percutaneously. The basic idea is to peg the AIIS fragment to the crescent frag still attached to the sacrum.
But the reported results of open treatment are very good, so your plan of ORIF should yield acceptable results.
Adam
|
[
Ответить ]
|
( Ответить )
|
|
comminuted crescent fx
