Pelvic fracture

The majority of pelvic fractures are caused by industrial accidents. The leading cause of pelvic trauma are the road accidents, the mortality is high, reaching up to 50% for open trauma, and between 8-20% for blunt trauma. They met as part of polytrauma with associated potential complications visceral.
Patients should receive an urgent comprehensive assessment of the lesions with at least one radiological standard abdominal ultrasound or CT scan.
Elementary mechanisms of injury are identified by imaging, there is a disjunction of vertical basin, external rotation or internal rotation.
During a pelvic [url=http://www.medecinesami.com]fracture[/url] on short-term prognosis is threatened by the bleeding complications that make the severity of pelvic [url=http://www.medecinesami.com]fracture[/url] in the acute phase. Severe septic complications and death are possible because of the ignorance of anorectal wounds.
The management is multidisciplinary and involves the visceral and orthopedic surgeons, the anesthetists and radiologists. Management of these trauma patients must take into account the vital urgency of technical facilities available to the team and so visceral complications is often difficult.
Treatment methods depend on the severity of the fracture, the type and number of associated complications. Before considering the management of various visceral complications. We must analyze the treatment of osteo-ligamentous lesions.
We must oppose the methods known orthopedic surgical methods for treating osteo-ligamentous injuries: external fixation, internal fixation in the open, closed osteosynthesis.
-By the methods are aimed at orthopedic climbs down and close the openings, reducing the vertical climb is permitted by the traction Transcondylar, but sometimes at the cost of a weight over 20 kg, it is maintained for 6 weeks.
Is placed at heights greater trochanters, the hammock Rieunau reducing external openings of the basin, it poses the problem of nursing associate and he is left in place 6 weeks.
For little or displaced fractures but potentially unstable, the isolated ulcers are often the only treatment.
-Surgical methods they will stabilize the posterior lesions or lesions earlier.
It uses the open osteosynthesis or external fixation. Plugs were implanted either above the roof of the acetabulum between the anterior superior iliac spine and anterior inferior iliac spine, or they are planted on the crest of the hip bone, behind the anterior superior iliac spine using the external fixator.
The use of the image intensifier facilitates the introduction of the cards, particularly in cases of large displacement. There are risks of instability sheets and infection.
It addresses the symphysis pubis during osteosynthesis opened by median or by Pfannenstiel. By ilioinguinal we combine with affordable shutter part. The first allows a reduction of the fracture is fixed with two plates DCP 4 hole or 2 hole DCP plate, or DCP plate 4 holes. Anatomical plate 6 hole was used by Letournel. The risks of this are open osteosynthesis: the instability of the assembly and infection.
On the opposite hip bone of the sacroiliac joints, both plugs are planted percutaneously. Compression is achieved by a rectangular frame, the advantage of this framework are: radio-transparency and engagement in rotation, leaving the field open for femoral fixation or secondary laparotomy. The clamp Browner is a variant of the clamp Ganz, before a surgical management more rational it is often used temporarily clamp.
The attachment of posterior lesions using compression bars fixed between the two posterior superior iliac spines was proposed by Goldstein, Shaw, Dabezies. On a casualty in the prone position, the compression bars are put in place by two surgical approaches in relation to the posterior sacroiliac joints. The risk of this surgery is infectious in 20% of cases. Fixing disjunctions sacroiliac first by a direct anterior sacroiliac joint is given by Tile is a first setting out to damage the root of the lumbosacral trunk.
The methods of sacroiliac screws are different, screws based on the anterior cortex of the sacrum is offered by Letournel he exhibited a cardiovascular risk, this gesture is performed by percutaneous route in case of transforaminal sacral fracture, we can not be realized because the compression of the fracture by tightening may cause or aggravate injuries kind of cauda equina.
Rehabilitation of injured depends on the severity of trauma, resuscitation measures are based on:
-Correction of hypovolemia which bleeding is the leading cause among traumatized pelvis.
-It corrects the bleeding disorders that must be corrected without delay. It is necessary to anticipate these problems by transfusion of fresh frozen plasma (FFP).
-Using a heat sensor, body temperature is monitored. Transfusion products should be warmed. The wounded must be covered with insulated cover.
-It is necessary to correct metabolic acidosis among injured in shock by administration of sodium bicarbonate. We must regularly monitor arterial blood gases.
-Buerger said that the trauma of the pelvis have a high risk of developing thromboembolic complications is why we must prevent thromboembolic disease.
-In case of open fracture and early sepsis should be feared, it is related to superinfection of a uro-hematoma or HRP, or the breach of a rectal or vaginal wound. Bacteriological samples were performed aerobic and anaerobic blood cultures as sampling or intraoperative pelvic effusion or intra-peritoneal.