External fixation of the pelvis.
During the past decade the useful classification and principles of management of the fractured pelvis have progressed rapidly. For the acute management the principal consideration is the control of severe intrapelvic hemorrhage. A protocol has been developed that combines the early application of external fixation with a closed reduction of the pelvic fracture. A marked decrease in the anticipated amount of intrapelvic hemorrhage has been documented. The coupled double anterior frame and its biomechanical equivalent, the newly developed triangular system, are easily applied to the pelvic ring and provide adequate stability for the treatment of the patient with a stable or unstable pelvic ring fracture. Thus the complex earlier design has been replaced by a simpler system. The triangular frame provides adequate stability so that the patient can undertake independent bed-to-chair transfers and early resumption of a weight-bearing gait. Late pulmonary, gastrointestinal, and urologic complications with prolonged bed rest and cast immobilization therefore have greatly diminished. In the present series in which external fixation has been applied to unstable pelvic ring fractures with a single posterior disruption, late loss of reduction, nonunion, and malunion almost have been entirely avoided. In addition, a simple triangular frame provides access to the abdominal wall and offers minimal postoperative interference with nursing care of the patient. Once the general condition of the patient has stabilized, supplementary techniques of open reduction and internal fixation may be applied to appropriate complex fracture patterns. These methods are fully reviewed elsewhere. Thus early rigid stabilization of the patient who sustains a pelvic ring fracture facilitates diminution of fracture pain, early mobilization of the patient, discharge, improved morale, and ultimately, decreased fracture morbidity and mortality.