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

back to skeleton

Glossary

Primary survey

Please select a treatment option:
Treatment Main indication Skill Equipment
Airway ATLS step number 1 Some specialized surgical experience Basic equipment only
Breathing ATLS step number 2 Some specialized surgical experience Basic equipment only
Circulation ATLS step number 3 Some specialized surgical experience Basic equipment only
Disability ATLS step number 4 Some specialized surgical experience Basic equipment only
Exposure and environmental control ATLS step number 5 Some specialized surgical experience Basic equipment only

Secondary survey

Please select a treatment option:
Treatment Main indication Skill Equipment
Secondary survey Injured patient with possible pelvic injury and/or hemodynamic instability Some specialized surgical experience Basic equipment only

Acute pelvic treatment

Please select a treatment option:
Treatment Main indication Skill Equipment
Extraperitoneal pelvic packing Unstable pelvis, hemodynamic instability, unresponsive to resuscitation Highly experienced and skilled surgeon Basic equipment only
Angio embolization Hemodynamically unstable patient, especially with arterial bleeding Highly experienced and skilled surgeon Full specialized surgical and imaging resources
External fixation: Emergency stabilization with a C-clamp Mechanically unstable pelvic ring without obvious innominate bone comminution or fracture line at pin site Highly experienced and skilled surgeon Full specialized surgical and imaging resources
External fixation Unstable pelvis with hemodynamic instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

A.1 Avulsion fractures of the innominate bone

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable displacement Basic surgical experience, no specialized skills Basic equipment only
ORIF; apophyseal avulsion fracture Gross displacement Some specialized surgical experience Basic equipment only

A2.1 Direct blow fracture of the iliac wing

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable deformity and displacement Basic surgical experience, no specialized skills Basic equipment only
ORIF; iliac crest Large fragment with significant displacement Some specialized surgical experience Simple surgical and imaging resources

A2.2/3 Uni- or bilateral blow fracture of the anterior pelvic arch

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable fracture deformity Basic surgical experience, no specialized skills Basic equipment only
Pubic symphysis plate Significant symphyseal displacement Some specialized surgical experience Simple surgical and imaging resources
Pubic ramus plate Significant displacement Some specialized surgical experience Simple surgical and imaging resources
Pubic ramus screw Significant displacement Some specialized surgical experience Simple surgical and imaging resources

A3.1 Sacrococcygeal dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Almost all coccygeal dislocations Basic surgical experience, no specialized skills Basic equipment only

A3.2 Undisplaced sacral fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Essentially all A3.2 sacral fractures Basic surgical experience, no specialized skills Basic equipment only

A.3.3 Displaced sacral fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Displaced distal sacral fractures without indications for surgery Basic surgical experience, no specialized skills Basic equipment only
ORIF Plate Associated sacral plexus nerve root deficit Basic surgical experience, no specialized skills Basic equipment only

B1 Unilateral partial injury of the posterior pelvic arch with external rotation (open book)

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Minimally displaced, stable injury Basic surgical experience, no specialized skills Basic equipment only
External fixation and traction (resource-limited) Unstable B1 pelvic injury and cranial displacement Some specialized surgical experience Basic equipment only
Operative treatment Unstable B1 pelvic ring injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

B2 Unilateral partial injury of the posterior pelvic arch with internal rotation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonperative Stable B2 injuries with acceptable deformity Basic surgical experience, no specialized skills Basic equipment only
ExFix and traction in resource limited settings Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
External fixation Significant internal rotation deformity or lower extremity shortening Highly experienced and skilled surgeon Simple surgical and imaging resources
Operative treatment Significant internal rotation deformity; symphyseal disruption Highly experienced and skilled surgeon Full specialized surgical and imaging resources

B3 Bilateral partial injury of the posterior arch of the pelvic ring

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Minimally displaced, stable injuries Basic surgical experience, no specialized skills Basic equipment only
External fixation and traction (resource-limited) Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment Pelvic deformity; symphyseal disruption Highly experienced and skilled surgeon Full specialized surgical and imaging resources

C1.1 Unilateral complete fracture of the posterior ilium

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment C1.1 pelvic ring injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

C1.2 Unilateral complete injury though the SI joint

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment C1.2 pelvic ring injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

C1.3 Unilateral complete fracture though the sacrum

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment C1.3 injury; nerve root involvement Some specialized surgical experience Full specialized surgical and imaging resources

C2 Unilateral complete, ipsialteral partial injury of the posterior pelvic arch

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment C2 pelvic ring injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

C3 Bilateral completely unstable posterior pelvic ring injuries

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment C3 pelvic ring injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Sacral fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources
External fixation Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF sacrum Displaced unstable (Type C) sacral fracture + nerve root injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Iliosacral screw for sacrum Well aligned, unstable sacral alar fracture; neurologically intact Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Iliosacral screw navigation Well aligned, unstable sacral alar fracture; navigation technology available Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Triangular osteosynthesis Vertically unstable transforaminal sacral fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ilioiliac plate Displaced, unstable sacral alar fractures, especially bilateral Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Spinopelvic fixation Transverse central sacral fracture, displaced or unstable; nerve root injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

SI-joint fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource-limited) Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources
External fixation Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
Anterior ORIF SI fracture Anterior open reduction of SI and fracture fixation Highly experienced and skilled surgeon Simple surgical and imaging resources
Posterior ORIF SI fracture Posterior open reduction of SI and fracture fixation Highly experienced and skilled surgeon Simple surgical and imaging resources
Iliosacral screw for sacrum Unstable SI joint, satisfactorily reduced Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Iliosacral screw navigation Unstable SI joint, satisfactorily reduced; same as for standard C-arm technique Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterior ORIF SI Joint Inability to gain closed reduction of SI joint Highly experienced and skilled surgeon Simple surgical and imaging resources

Iliac fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource limited) Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources
External fixation Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF ilium Displaced or unstable posterior iliac fracture with unstable pelvic ring Highly experienced and skilled surgeon Simple surgical and imaging resources

Pubic ramus fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Stable undisplaced pubic ramus fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Displaced pubic ramus fractures with unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
Pubic ramus plate Part of combined anterior and posterior fixation for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
Pubic ramus screw Alternative to plate fixation of unstable ramus fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Pubic symphysis fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Pubic symphysis plate Pubic symphysis disruption with type B or C pelvis instability Highly experienced and skilled surgeon Simple surgical and imaging resources

Stable ring fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Most closed Type A fractures without gross deformity or displacement Basic surgical experience, no specialized skills Simple surgical and imaging resources
ORIF; apophyseal avulsion fracture Significantly displaced apophyseal fractures Some specialized surgical experience Simple surgical and imaging resources
ORIF; iliac crest Large displaced A2 iliac wing fracture Some specialized surgical experience Simple surgical and imaging resources
ORIF sacrum Associated sacral plexus nerve root deficit Highly experienced and skilled surgeon Simple surgical and imaging resources
*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