Simple anterior pelvic external fixation

Background: Unstable pelvic ring disruptions are often associated with sign ificant morbidity and mortality, especially in patients with multiple injur ies. Early pelvic fixation provides stability and should diminish ongoing h emorrhage, A simple anterior single-pin pelvic external fixator fan be appl ied rapidly and accurately to stabilize pelvic ring injuries as a part of t he initial patient resuscitation of such patients. Simple anterior pelvic e xternal fixation (SAPEF) frames can be used as either temporary, definitive , or supplementary fixation depending on the pelvic injury pattern. Methods: Over a 32-month period, 41 patients with unstable pelvic ring disr uptions were stabilized using a simple anterior pelvic external fixator. Ei ght patients had open pelvic ring injuries and 13 others had genitourinary system disruptions. Fluoroscopic imaging was used to insert all of the fixa tion pins into the iliac crest between the iliac cortical tables to a depth of at least 5 cm. Each patient had closed manipulative reduction of the pe lvic ring using external methods before SAPEF application. Results: One patient died less than 24 hours after injury because of torren tial hemorrhage. Clinical evaluations and serial radiographs, including pos toperative computed tomographic scans, were available for the other 40 pati ents postoperatively, Seventy-five of the 80 (94%) pins were completely con tained between the iliac cortical tables, according to the computed tomogra phic scans. The initial pelvic closed reductions were maintained until the fixators were removed in 37 of 40 patients (93%). Only one deep pin track i nfection developed, mandating early frame removal and intravenous antibioti c therapy, Conclusion: Simple anterior pelvic external fixation can be applied rapidly using fluoroscopic guidance to direct accurate pin insertion and closed ma nipulative reduction of the pelvis. Depending on the specific pelvic ring i njury pattern and clinical scenario, SAPEF can serve as a resuscitative tem porary fixation device, as definitive pelvic treatment, or as a supplement for pelvic internal fixation implants.