Fractures of the pelvis: principles of diagnosis and treatment (new concepts)
Pelvis fractures are generally caused by high-energy trauma. The early mortality rate approaches to 10% and neurologic deficit, pelvic deformity leg-length inequality, hernia and chronic pain are the possible significant late sequela which cause difficulty in daily life. Treatment should first begin with evaluation of stability and surgeon should decide if the fracture is stable or not. Conservative measures would be appropriate for stable or nondisplaced fractures. More than 2.5 cm separation of the symphysis that can not be reduced by closed manipulation and more than 1 cm displacement at the posterior sacroiliac complex require surgical treatment, that is, open reduction. External fixation alone is not adequate for maintaining instability and therefore should be combined with internal fixation. Anterior and posterior internal fixation of symphysis and sacroiliac joint respectively provides biomechanically the most stable fixation. External fixation in the initial phases of treatment provides stability and enhances tamponade so that hemorrhage minimized and the patient becomes more hemodynamically stable. Furthermore it may be adequate for maintaining reduction of partially unstable (Type B) fractures.
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