Injury
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Review
Pelvic and acetabular surgery within Europe: the need for the co-ordination of treatment concepts.
Pelvic and acetabular injuries are rare and represent the tip of the trauma iceberg. They often present with other associated injuries. Their management can pose difficulties even to the most experienced trauma surgeons and well-developed trauma systems. ⋯ By means of sharing ideas and results, "learning curves" of individuals and nations could be shortened. As a result, better health quality and advanced medical facilities for our future patients may be anticipated. In this article we examine the current problems affecting the provision of a high quality pelvic and acetabular service and analyse the needs for the co-ordination of treatment concepts within the European Landscape.
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Based on low incidence and lack of personal experience only few evidence based studies exist on several questions in pelvic and acetabular surgery. As part of an international consensus pelvic and acetabular course personal preferences and experience of an distinguished faculty and senior participants were discussed and we summarize in the paper the consented opinions and trends. Topics included the emergency treatment of life threatening pelvic ring injuries, treatment strategies in unstable sacral fractures, preferred surgical methods for transiliosacral screw fixation of the posterior pelvic ring, the value of CT and conventional radiographs in diagnostic of acetabular fractures, the choice of approach for treatment of acetabular fractures, the open vs. arthroscopic treatment of the femoro acetabular impingement of the hip and the treatment modalities in pelvic and acetabular fractures in geriatric patients. One has to keep in mind that this statements may help in the process of personal decision making in this difficult surgical field, but should not act as evidence based recommendations.
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During the last decade navigation techniques in pelvic and acetabular surgery have been described. Nowadays, available techniques include CT-based navigation, 2D C-arm navigation and 3D C-arm navigation. The main indication is the navigated percutaneous SI screw fixation, but acetabular screw fixations are also reported. In this article, based upon a literature review and our own clinical experiences, the indications for and limitations of navigated techniques in pelvic and acetabular surgery are described.
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Multicenter Study
The German Multicentre Pelvis Registry: a template for an European Expert Network?
The range of severity of pelvic injuries is wide and can include simple, undisplaced pelvic fractures, which may limit the activity of the individual patient for only a short period of time, and severe, complex or even open pelvic fractures, causing immediate life threatening situations. Even with continuous progress in development of techniques and treatment protocols, primary treatment and definitive reconstruction of pelvic ring injuries and acetabular fractures there is still an ongoing debate about specific problems in the evaluation of injuries and fractures. Because of the low incidence of pelvic fractures (37/100,000) the individual experience, which can be acquired by the surgical team, even in major Trauma Centres, is limited and can only be acquired over a longer period of time. ⋯ As this registry is already designed as an open platform, not limited in capacity and regions, it provides a platform, which may easily be expanded to the European level allowing for international multicentre studies and case sampling. Therefore this type of pelvic registry could act as a basis for further scientific evaluation of specific topics in the field of pelvic and acetabular surgery and could be a template for a European Expert Network. Driven by the differences of healthcare systems and organisation of trauma care within Europe and the challenge that pelvic fractures not only can lead to permanent disability, but also play an important role in posttraumatic fatalities, a clear need can be shown for detailed analysis of the present situation within the different European nations.
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The primary goal in the treatment of pelvic fractures is the restoration of haemodynamic stability. The secondary goal is the reconstruction of stability and symmetry of the pelvic ring. Percutaneous reconstruction can only be accepted if these goals are met. ⋯ Techniques of placement of both screws are demonstrated. Open reduction and internal fixation remains the standard of care in stabilisation of pelvic and acetabular fractures. Only the experienced surgeon will be able to judge if percutaneous procedures can be an alternative or a useful additive to conventional techniques.