OTA 2000 Posters

Poster #2

*Pelvic Ring Disruptions: Reduction by Means of Circumferential Compression Using A Sling

Tamara Simpson, MD; James C. Krieg, MD; Steven M. Madey, MD; Michael Bottlang, PhD; Juergen Sigg, Oregon Health Science University, Portland, OR (all authors-Legacy Research Foundation Grant)

Purpose: Early reduction and stabilization of pelvic fractures can effectively control retroperitoneal hemorrhage. Most recently, anecdotal use of circumferential sheets and belts to reduce pelvic disruptions has been reported. However, neither the required amount nor the optimal application site of circumferential compression has been investigated. This research aims to derive essential parameters for the application of circumferential compression to reduce pelvic fractures emergently.

Methods: Partially stable pelvic 'open book' fractures (OTA classification 61-B1) and unstable pelvic fractures (OTA 61-C1) with 50 mm and 100 mm symphysis diastasis, respectively, were created subsequently in 7 fresh frozen whole-body specimens. A 50-mm-wide sling was utilized to circumferentially compress and reduce the pelvic fractures. Each specimen was instrumented with sensors to detect symphysis closure and to trace displacement and reduction of the pelvic ring. The sling was instrumented with sling tension (Ft) and skin-sling interface pressure sensors. This sling was applied at 3 distinct levels, starting just proximal to the pubic symphysis (level I), midway between the pubis symphysis and the iliac crest (level II), and at the level of the iliac crest (level III). The sling was gradually tightened to induce pelvic fracture reduction and symphysis closure. Pre- and post-reduction inlet and outlet radiographs were obtained for each specimen to verify the fracture pattern and to observe the quality of reduction.

Results: Inlet and outlet radiographs confirmed successful creation of partially stable and unstable 'open book' type pelvic fractures in all specimens, resulting in symphysis diastasis of 56 ± 6 mm and 99 ± 6 mm, respectively. Pelvic reduction (i.e., symphysis contact) was achieved by sling application at level I with FT = 177 N ± 44 N for the partially stable pelvis and with FT = 180 N ± 50 N for the unstable pelvis. Sling application at levels II and III required significantly higher sling tension (_ = 0.05) to achieve symphysis contact. Sling application at level I yielded an intraperitoneal pressure increase of 10.1 ± 9 mmHg at symphysis closure. The average skin-sling interface pressure was 24 mmHg at symphysis closure for sling application at level I.

Discussion and Conclusion: Reduction of 'open book' pelvic fractures was consistently achieved using a non-invasive pelvic sling to circumferentially compress the pelvis. An optimal sling position and the required sling tension to achieve reduction have been determined. These findings supports the application of controlled circumferential compression as an efficient, non-invasive method to emergently reduce and stabilize open book pelvic fractures.