242
Injury,
7, 242-243
Wrinkle
Corner
Fixation device for pubic fractures E. S. Saadah and T. A. English Orthopaedic Surgeon and Orthopaedx Humberside WIDE separation
of the pubic bones, combined with a posterior pelvic injury, is usually stabilized after reduction by external support using a pelvic sling, or by internal fixation using interpubic wires or plates. A rather unusual case is described in which neither method was applicable, and for which alternative fixation was devised.
CASE
REPORT
A 56-year-old man weighing 164 st (23 I lb, 105 kg) was injured in a motor accident and was admitted to hospital with a severe pelvic injury. There was no other serious injury and no involvement of the urinary tract. The radiograph (Fig. 1) shows wide separation of comminuted pubic fractures associated with sacro-iliac disruption. After resuscitation, the pelvic injury was reduced easily by manual compression in the lateral position under general anaesthesia. However, his extreme bulk and a restless temperament made external means of pelvic support in bed impracticable, and the pubic
Fig. 1. Radiograph
of the patient on admission.
Registrar, Hull Royal Infirmary,
fractures precluded the usual internal fixation methods. A pelvic compression device (Fig. 2) was made by modifying Blackburn’s skull callipers so that horizontal pelvic compression could be maintained in comfort. Under local anaesthesia, through short incisions, the fixation pins were inserted through the outer cortex of the ilium close to the anterior superior iliac spines. The weight of the appliance, but not that of the patient, was suspended, using a counterweight, from a beam over the bed. In this case the patient remained in bed for 3: weeks before removal of the device. Some patients could be allowed to move about earlier with the device in situ. A radiograph taken 3 months after the accident showed early union. At this time the patient was free of pain and
Fig. 2. The pelvic compression
device.
Wrinkle
Corner:
Pubic
Fixation
243
Device
walking without a stick. The X-ray (Fig. 3) shows the device attached to another subject.
Acknowledgements We are grateful to Mr M. Kilvington
and Mr Stewart Rae of the Medical Physics Unit, Suttonupon-Hull, Humberside, for their technical assistance. Enquiries regarding this appliance should be made to: Charles F. Thackray Ltd, Park Street, Leeds, LSl 1RQ.
Fig. 3. Radiograph of the device in situ. Requests for reprints should be addressed to: T. A. English, Esq, The Hull Royal Intirmary, Accident, Emergency and Orthopaedic Service, Hull, HU3 ZJZ.
Injury,
7, 242-243
Wrinkle
Corner
Fixation device for pubic fractures E. S. Saadah and T. A. English Orthopaedic Surgeon and Orthopaedx Humberside WIDE separation
of the pubic bones, combined with a posterior pelvic injury, is usually stabilized after reduction by external support using a pelvic sling, or by internal fixation using interpubic wires or plates. A rather unusual case is described in which neither method was applicable, and for which alternative fixation was devised.
CASE
REPORT
A 56-year-old man weighing 164 st (23 I lb, 105 kg) was injured in a motor accident and was admitted to hospital with a severe pelvic injury. There was no other serious injury and no involvement of the urinary tract. The radiograph (Fig. 1) shows wide separation of comminuted pubic fractures associated with sacro-iliac disruption. After resuscitation, the pelvic injury was reduced easily by manual compression in the lateral position under general anaesthesia. However, his extreme bulk and a restless temperament made external means of pelvic support in bed impracticable, and the pubic
Fig. 1. Radiograph
of the patient on admission.
Registrar, Hull Royal Infirmary,
fractures precluded the usual internal fixation methods. A pelvic compression device (Fig. 2) was made by modifying Blackburn’s skull callipers so that horizontal pelvic compression could be maintained in comfort. Under local anaesthesia, through short incisions, the fixation pins were inserted through the outer cortex of the ilium close to the anterior superior iliac spines. The weight of the appliance, but not that of the patient, was suspended, using a counterweight, from a beam over the bed. In this case the patient remained in bed for 3: weeks before removal of the device. Some patients could be allowed to move about earlier with the device in situ. A radiograph taken 3 months after the accident showed early union. At this time the patient was free of pain and
Fig. 2. The pelvic compression
device.
Wrinkle
Corner:
Pubic
Fixation
243
Device
walking without a stick. The X-ray (Fig. 3) shows the device attached to another subject.
Acknowledgements We are grateful to Mr M. Kilvington
and Mr Stewart Rae of the Medical Physics Unit, Suttonupon-Hull, Humberside, for their technical assistance. Enquiries regarding this appliance should be made to: Charles F. Thackray Ltd, Park Street, Leeds, LSl 1RQ.
Fig. 3. Radiograph of the device in situ. Requests for reprints should be addressed to: T. A. English, Esq, The Hull Royal Intirmary, Accident, Emergency and Orthopaedic Service, Hull, HU3 ZJZ.
