Temporary External Fixation to Table as a Traction Reduction Aide in the Treatment of Unstable Pelvic Ring Injuries: A Technical Note

Abstract

Displaced pelvic ring injuries can be challenging to even the experienced orthopedic traumatologist. A temporary external fixation to table construct provides a quick, simple, and accessible means of external skeletal fixation to reliably obtain and maintain stable hemipelvis reduction on the operating room table. The contralateral hemipelvis can be stabilized to the table by use of Steinman pins safely inserted into the subtrochanteric and anterior column regions and later connected to external fixator bars attached to the table. With rigid stabilization, the displaced contralateral pelvic fragment(s) can be reduced in a more vector intentional manner with greater force than the traditional means of pelvic reduction can allow. The skeletal-table fixation technique is presented along with two cases, a combined pelvic-acetabular injury and an isolated pelvic ring injury.

Keywords: External fixators; Fracture fixation; Pelvis.

Fig. 1. Placement of Steinmann pins. (A) Anterior column pin directed distally, medially, and posteriorly, starting at the gluteus medius tubercle. (B) Subtrochanteric pin.

Fig. 2. (A, B) Supine positioning following Steinman pin placement to Rt femur and pelvis, external fixation clamps and fiberglass bars are attached to the table by position clamps. (C) The left leg was placed in skeletal traction adjusted by the table's gross and fine traction bar for anatomical reduction.

Fig. 3. Table-skeletal external fixator constructs.

Fig. 4. Severe traumatic windswept lateral compression injury in a 24-year-old male.

Fig. 5. (A) Post-definitive fixation radiographs following the use of the Table-Skeleton technique and supraacetabular external fixation pin placement with inlet and outlet radiographs. (B) 3 months postoperative after ex-fix removal. (C) 6 months postoperative.

Fig. 6. Traumatic lateral compression injury in a 37-year-old female with a displaced, concomitant T-type acetabular fracture. Note the left-sided illiosacral diastasis.

Fig. 7. Post-definitive fixation radiographs following use of the Table-Skeleton technique for contralateral hemipelvis stabilization.