A Massé, D Aloj, A Aprato, R Matteotti, A Biasibetti, M Favuto (Turin, Italie)
Among the different kinds of external stabilization the external fixation of the pelvis should ideally be performed in the emergency room, quickly, possibly without need of image intensifier and should not interfere with a surgical abdominal treatment. An external fixator of the pelvis was designed (Blue Shark, Mikai, Italy) with the following characteristics: it allows for implant of the screws either on the iliac crest, in the supra-acetabular region or combined, the fixator is x-ray transparent and MRI compatible; to fasten the implant is packed in blisters with all the ancillary instruments and disposable
Since July 2005 47 Blue Shark fixators were implanted in emergency; the lesions were staged as B1 in 25 cases, B2 in 4 cases, C1 to C3 in 18 cases.
The hemodinamical conditions of the patients improved in all but 4 cases that died due to massive bleeding. The mean time from the arrival and the implant was 35 minutes (range 12 to 90), while the mean implant time was 15 minutes. In 34 cases the implant was performed without image intensifier; the subsequent radiograph showed correct screw position in all cases. In 6 patients a laparotomy was performed and in 2 bladder suture after the implant. Subsequent definitive treatment was performed on 36 cases, while the fixator was the only treatment in 11 patients.
The emergency fixation of the pelvis significantly improve the outcome of the hemodinamically unstable patients. A fast implant technique seems to be suitable avoiding any interference with subsequent surgical procedures.