[Injury to the pelvic ring. Diagnosis and current possibilities for treatment].
Pelvic fracture, especially in combination with multiple trauma, can still lead to ife-threatening situations. Only clear inclusion criteria and decisions can ensure survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-orientated management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. The classification groups postulated are stable pelvic fractures (type A), rotational unstable pelvic fractures (type B -- partial stability of the posterior ring present), and translational instabilities (type C -- with a complete disruption of the anterior and posterior pelvic ring). This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.
Culemann
U
U
Chirurgische Universitätsklinik, Abteilung für Unfallchirurgie, Homburg/Saar. ulf_culemann@t-online.de
Tosounidis
G
G
Reilmann
H
H
Pohlemann
T
T
D004630:Emergencies; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D009104:Multiple Trauma / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016103:Spinal Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed