AOTrauma Webinar:  Why Do Patients Get Infection?

May 30, 2017 14:00 CET

Main Presenter: Olivier Borens, MD (Switzerland)
Chat Moderator: Stephen Kates, MD (USA)

Surgical site infections after trauma are debilitating and costly. They are feared by the surgeon and the patient alike. The incidence of this complication can be decreased by proper preoperative, intraoperative, and postoperative management.
The goal of this webinar is to present easy-to-use tools and strategies that will lead to a decrease in the incidence of infection.

More information and registration...

Infection

Executive Editor: Peter Trafton

Authors: Rahul Banerjee, Peter Brink, Matej Cimerman, Tim Pohlemann, Matevz Tomazevic

Pelvic ring - B1

back to skeleton

Glossary

General considerations

Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.

Surgical treatment is advisable for B1 pelvic ring injuries. It usually involves ORIF of the pubic symphysis. External fixation is less effective than ORIF for symphysis disruptions.

Theoretically, anterior arch repair and healing should stabilize true B1 injuries. However occult instability may be present. If it is, posterior fixation is advisable (usually percutaneous iliosacral screw fixation). Alternatively, follow-up should be more intensive during the first 1-2 months after symphyseal repair.

Nonoperative
Main indication Skill Equipment
Minimally displaced, stable injury Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Minimally displaced injury that appears stable. (Less than 1-2 cm symphyseal diastasis)

Contraindications

  • Posterior pelvic ring instability (by physical exam or imaging)
External fixation and traction (resource-limited)
Main indication Skill Equipment
Unstable B1 pelvic injury and cranial displacement Some specialized surgical experience Basic equipment only

Indications

  • Unstable B1 pelvic injury with possible posterior S-I ligament insufficiency, suggested by cranial displacement of the involved hemipelvis. (If no cranial displacement, external fixation may be sufficient by itself
  • Need to delay definitive surgery because of patient's condition

Contraindications

  • Ability to provide definitive pelvic ring fixation without excessive delay
Operative treatment
Main indication Skill Equipment
Unstable B1 pelvic ring injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.

Indications

  • Unstable B1 (external rotation) pelvic ring injury
  • Progressive deformity (increasing pubic diastasis)
  • Pubic diastasis 1-3 cm, or greater
  • During laparotomy for associated visceral injury (if symphysis is unstable)
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2015-12-10