title: The use of external fixators in the definitive stabilisation of the pelvis in polytrauma patients: Safety, efficacy and clinical outcomes.
abstract: OBJECTIVE
  To analyse the complications and outcomes (functional/radiographic) of Pelvic External Fixators applied as part of the definitive fixation in polytrauma patients.
  
  
  METHODS
  A single center retrospective chart review.
  
  
  METHODS
  A level-1 trauma center.
  
  
  METHODS
  We reviewed all the polytrauma patients (ISS>16) between 2007 and 2012 that had a PEF applied more than 30days. Complications including infection, aseptic loosening, neurological injury, loss of reduction, non-union and mal-union were recorded. Pelvic asymmetry and Deformity Index (DI) were measured at the immediate postoperative radiographs and final follow-up. The functional outcome at final follow up was estimated using a scale previously reported by Chiou et al.
  
  
  RESULTS
  59 patients with mean age of 38.4 (16 - 81) years and mean ISS score 28 (16- 66) were included. The PEFs were applied for mean duration of 56 (30-104) days. The average follow-up was 403days. 22 injuries were type B and 37 type C (AO/OTA). The most common symptomatic complications were pin site infection in 11 (18.6%) and loosening in 5 (8.5%) cases. 44 (74.5%) patients had satisfactory functional outcome. The immediate post-operative and final asymmetry and DI were compared between the two pelvic injury groups (type B and C fractures). The difference in displacement progression was more for type C injuries (p=0.034) but no correlation to the functional outcome was evident.
  
  
  CONCLUSIONS
  PEF can be used as definitive alternative stabilization method in specific situations at polytrauma setting. Radiological displacement occurred in both type B and C injuries but the clinical outcome was not correlated to this displacement. Complications related to PEF do not affect the final clinical outcome.
  
  
  METHODS
  Therapeutic Level III.
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA West Yorkshire, Leeds, UK. Electronic address: ttosounidis@yahoo.com.
authors.forename: Theodoros H
authors.initials: TH
authors.lastname: Tosounidis
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK. Electronic address: hqsheikh@gmail.com.
authors.forename: Hassaan Qaiser
authors.initials: HQ
authors.lastname: Sheikh
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK. Electronic address: nikolaoskanakaris@yahoo.co.uk.
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Kanakaris
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA West Yorkshire, Leeds, UK. Electronic address: pgiannoudi@aol.com.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
keywords: Pelvic external fixator; Pelvic ring injuries; Polytrauma