Pelvic ext
-
Upload
dr-mohit-sharma -
Category
Education
-
view
61 -
download
1
Transcript of Pelvic ext
![Page 1: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/1.jpg)
PELVIC FRACTURES:EXTERNAL FIXATION
DR. MOHIT SHARMADR. ANKIT MADHARIA
JUNIOR RESIDENTLATA MANGESHKAR HOSPITAL
![Page 2: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/2.jpg)
Pelvic Ring Injuries
High energy
Morbidity/Mortality
Hemorrhage
![Page 3: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/3.jpg)
Pelvic Ring Injuries
An unstable pelvic injury may allow hemorrhage to collect in the true pelvis as there is no longer a constraint which allows tamponade.
Best estimated by a hemi-elliptical sphere(Stover et al, J Trauma, 2006)
![Page 4: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/4.jpg)
Hemorrhage Control: Methods
• Closed reduction of pelvis at admission.
• External fixation.• Control of haemorrhage.• Pelvic packing.• Angiography.• Control of contamination.• Repair of genitourinary and rectal
injuries.• Debridement of necrotic tissue in
case of open injury.
![Page 5: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/5.jpg)
Circumferential Sheeting
• Supine
• 2 “Wrappers”
• Placement
• Apply
• “Clamper”
• 30 Seconds
1
2
34
Routt et al, JOT, 2002
![Page 6: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/6.jpg)
Pelvic Binders
Commercially available.Placed over the TROCHANTERS and not over the abdomen and chest.
![Page 7: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/7.jpg)
External Fixation• Location
AIIS(low route frame)
ASIS(high route frame)
C-clamp
![Page 8: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/8.jpg)
External Fixation:Considerations
• Pin size
• Number of pins
• Frame design.
• Frame location.
![Page 9: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/9.jpg)
EXTERNAL FIXATOR FRAMES:
ASIS FRAME DESIGNS/HIGH ROUTE FRAMES:
![Page 10: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/10.jpg)
Most commonly used is a simple two pin external fixator design.
![Page 11: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/11.jpg)
SURGICAL LANDMARK AND INCISION:
![Page 12: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/12.jpg)
![Page 13: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/13.jpg)
![Page 14: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/14.jpg)
Technical Details: ASIS frames…
• Fluoroscopy dependent• 3 to 5 cm posterior to the ASIS• Along the gluteus medius pillar• Pin entry at the junction of the lateral
2/3 and medial 1/3 of the iliac crest• Aim: 30 to 45 degrees (from lateral
to medial)
• Towards hip joint, convergent pins.
![Page 15: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/15.jpg)
Pin Orientation: ASIS
![Page 16: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/16.jpg)
Outlet Oblique Image
• Inner Table
• Outer Table
• ASIS
![Page 17: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/17.jpg)
Outlet Oblique Image
• Inner Table
• Outer Table
• ASIS
![Page 18: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/18.jpg)
![Page 19: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/19.jpg)
Technical Details: AIIS frames…
• Fluoroscopy dependent:• Incision 2-3 cm distal to ASIS
directed toward the anticipated final location.
• Gently spreading soft tissues .• Aiming 20-30 degrees
medially.
![Page 20: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/20.jpg)
Pin Orientation: AIIS
![Page 21: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/21.jpg)
Pin Orientations
![Page 22: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/22.jpg)
Anti-shock Clamp (C-clamp)
Better posterior pelvis stabilization
Allows abdominal access
Can be combined with pelvic packing
![Page 23: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/23.jpg)
Anti-shock Clamp (C-clamp)
![Page 24: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/24.jpg)
Anti-shock Clamp (C-clamp)
The insertion points for the pins lie on the crossing point of the femoral shaft axis and on a vertical line starting just caudal to the anterior superior illiac spine.
![Page 25: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/25.jpg)
![Page 26: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/26.jpg)
![Page 27: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/27.jpg)
![Page 28: Pelvic ext](https://reader035.fdocuments.us/reader035/viewer/2022062412/58d1c17b1a28ab705c8b47a9/html5/thumbnails/28.jpg)
THANK YOU