APPLICATION OF ANTERIOR FRAME

Indications

Fixation of pelvic fractures associated with major bleeding including AP (anteroposterior) II, AP III, LC (lateral compression) II, LC III, vertical shear fractures and fractures with a combined mechanism of injury, according to Young's classification. Depending on the type of pelvic injuryandwhenthe physiological status of the patienthas been normalized, the external fixator could be exchanged with an open reduction and internal fixation procedure of the pelvic ring. This usually takes place after the 4th or 5th day from the time of the injury.

Pre-operative planning

Clinical assessment

• Inspection of the anterior lateral and posterior aspect of the pelvic ring would allow evaluation about the extent of the soft tissue damage.

• Neurological examination of the lower limbs is of paramount importance.

• Careful inspection of the perineal region would allow identification of open fractures. Evaluation of the genitourinary system is of vital importance in order not to missanyinjuries to the urethra, bladderandthe vaginal walls.

Radiological assessment

• Standard anteroposterior radiographs demonstrate the type of fracture.

• Accurate evaluation of the injury to the posterior elements of the pelvic ring (sacrum and sacroiliac joint) require CT scan evaluation.

• Inlet and outlet views would allow accurate evaluation of the displacement of the hemi-pelvis, providing useful information to the surgeon regarding the manoeuvres necessary in theatre for accurate reduction of the fracture.

Timing of surgery

• The application of an external fixator on the pelvis in the presence of hypovolaemia is an emergency procedure. This can be performed either in a trauma room or in the operating theatre.

Operative technique

Anaesthesia

• General anaesthesia.

• Administration of prophylactic antibiotics as per local hospital protocol.