Noninvasive reduction of open-book pelvic fractures by circumferential compression.
OBJECTIVE
To determine the efficacy and optimal application parameters of circumferential compression to reduce external rotation-type pelvic fractures.


METHODS
Biomechanical investigation on human cadaveric specimens.


METHODS
Biomechanics laboratory.


METHODS
Partially stable and unstable external rotation injuries of the pelvic ring (OTA classification 61-B1 and 61-C1) were created in seven human cadaveric specimens. A prototype pelvic strap was applied subsequently at three distinct transverse levels around the pelvis. Circumferential pelvic compression was induced by gradual tensioning of the strap to attempt complete reduction of the symphysis diastasis.


METHODS
Pelvic reduction was evaluated with respect to strap tension and the strap application site. The effect of circumferential compression on intraperitoneal pressure and skin-strap interface pressure was measured.


RESULTS
A successive increase in circumferential compression consistently induced a gradual decrease in symphysis diastasis. An optimal strap application site was determined, at which circumferential compression most effectively yielded pelvic reduction. The minimum strap tension required to achieve complete reduction of symphysis diastasis was determined to be 177 +/- 44 Newtons and 180 +/- 50 Newtons in the partially stable and unstable pelvis, respectively.


CONCLUSIONS
Application of circumferential compression to the pelvic soft tissue envelope with a pelvic strap was an efficient means to achieve controlled reduction of external rotation-type pelvic fractures. This study derived application parameters with direct clinical implication for noninvasive emergent management of traumatic pelvic ring disruptions.
Bottlang
Michael
M
Biomechanics Laboratory, Legacy Health System, and Oregon Health Sciences University, Portland, Oregon 97232, USA.
Simpson
Tamara
T
Sigg
Juergen
J
Krieg
James C
JC
Madey
Steven M
SM
Long
William B
WB
D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000293:injuries* / Q000503:physiopathology; D011312:Pressure