ACETABULAR AND PELVIC FRACTURES IN MULTIP LE TRAUMA

We see pelvic fractures in about 50% of all multiple trauma patients. In many cases, these pelvic fractures are complicated by complex pelvi c traumata, i.e., a pelvic fracture with pelvic vessel damage, neurolo gical, visceral or soft-tissue damage, and therefore have the characte r of life-threatening lesions. The incidence of complex pelvic trauma is extremely high in cases of vertical and rotation instability. Most problems come from massive bleeding as a result of presacral Venous pl exus laceration. This Venous bleeding usually tampons its self after s tabilization, e. g., with an external fixator. In about half of the ca ses an immediate laparotomy is performed because of remaining circulat ory instability, lesions of the urinary tract, or open fractures. In t hese cases, stabilization of the pelvis is frequently achieved by ORIF , e.g., plating of the symphysis pubis or the SI joint. Internal stabi lization of the pelvis facilitates the following treatment in the ICU, especially when prone-supine positioning is mandatory due to pulmonar y indications. For this reason we avoid traction techniques in displac ed acetabular fractures, and we achieve stability with a joint-bridgin g external fixator. Treatment of complex pelvic fracture must be integ rated in the overall concept of treatment. Differentiated and situatio n-adapted action is necessary, depending on the particular situation, as well as the personnel and technical equipment.