Injury
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Comparative Study
Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring.
This study tested different methods of internal fixation of a symphyseal disruption, in comparison with the mechanics of the intact pelvis. Unembalmed cadaveric pelves were tested in simulated bilateral stance in a servohydraulic materials-testing machine. Motion of the superior and inferior pubic symphysis, and at two levels of the posterior sacroiliac complex, was measured using high resolution displacement transducers. ⋯ There was no significant difference in sacral fracture motion between the three methods. The results indicate that in osteoporotic bone, as used in this study, symphyseal wiring is best able to oppose the tensile loads in the inferior symphysis that are associated with bilateral stance loading. These biomechanical findings must be interpreted within the broader context of surgical management of these complex injuries.
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Thirty-nine patients with unstable pelvic fractures were analysed retrospectively. The mean age of the group was 41 years (range 15-77). Of these cases 35 had sustained high energy trauma. ⋯ Additional therapy for hypovolaemic shock due to pelvic bleeding was necessary in six cases. The overall mortality in this series was 13 per cent. Early and aggressive resuscitation and standardized treatment in well-equipped and staffed injury centres is mandatory in these severely traumatized patients to achieve optimal results and to minimize the risk of fatal outcome.