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Comparison of iliac crest versus supraacetabular external fixator in hemodynamically unstable patients with a pelvic ring injury

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Abstract

Purpose

External fixation has been widely implemented as a resuscitation strategy in combination with pelvic packing for high energy, hemodynamically unstable, pelvic ring injuries. The primary aim of this study is to compare urgent iliac crest (IC) versus supraacetabular (SA) external fixation in the setting of haemodynamic instability.

Methods

This is a retrospective review of a prospectively gathered registry at an urban level one trauma centre comparing placement of pelvic external fixator by SA or IC technique. Outcomes assessed were accuracy of pin placement, duration of procedure, and the effect on true pelvic circumference depending on type of fracture by Young and Burgess Classification system.

Results

Ninety-three haemodynamically unstable patients with a pelvic fracture included. Pin malpositioning was more common with IC than SA groups (proportional difference, − 40%; 95% CI, − 57 to − 20%; p < 0.0001). For APC injuries, there was a larger median reduction in pelvic circumference in the SA group than the IC group (median difference [MD], − 12.85 cm; 95% CI, − 27 to 0.1; p = 0.0485). In LC injuries, the SA group had an overall increase in pelvic circumference compared to an overall decrease in IC group (MD, 6.5 cm; 95% CI, 1.5 to 16.8; p = 0.0221). There was no difference in the operating room (OR) time (mean difference, − 5.4 min; 95% CI, − 32 to 22; p = 0.68).

Conclusions

In this clinical setting, we recommend placement of SA external fixator (versus IC) with similar operative times, fewer pin malpositions, and improved stabilization of pelvic circumference in APC and LC injuries.

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Authors and Affiliations

  1. Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA

    Xiangquan Chu, Katya E. Strage, Michael Hadeed, Joshua A. Parry, August Funk, Clay Burlew & Cyril Mauffrey

Authors
  1. Xiangquan Chu
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  2. Katya E. Strage
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  3. Michael Hadeed
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  4. Joshua A. Parry
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  5. August Funk
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  6. Clay Burlew
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  7. Cyril Mauffrey
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Contributions

All authors contributed to the study conception and design, material preparation, data collection, and analysis. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cyril Mauffrey.

Ethics declarations

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Denver Health and University of Colorado, Denver Institutional Board Review approved this study.

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Not applicable.

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Not applicable.

Conflict of interest

Financial interests—Cyril Mauffrey has the following disclosures: Springer, publishing royalties and financial or material support, and Zimmer, research support. Joshua Parry has the following disclosures: Depuy Synthes, paid consultant. None of the other authors have financial interests to disclose.

Non-financial interests—Cyril Mauffrey has the following disclosures: Springer, editorial or governing board; DePuy, A Johnson & Johnson Company, Honorarium for educational courses; International Orthopaedics, editorial or governing board; and The European Journal of Orthopaedic Surgery and Traumatology, editorial or governing board. Joshua Parry has the following disclosure: The European Journal of Orthopaedic Surgery and Traumatology, editorial or governing board. Clay Burlew has the following disclosures: JTrauma, editorial or governing board, and TSACO, editorial or governing board. None of the other authors have non-financial interests to disclose.

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Chu, X., Strage, K.E., Hadeed, M. et al. Comparison of iliac crest versus supraacetabular external fixator in hemodynamically unstable patients with a pelvic ring injury. International Orthopaedics (SICOT) 45, 2121–2127 (2021). https://doi.org/10.1007/s00264-021-05005-5

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  • DOI: https://doi.org/10.1007/s00264-021-05005-5

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