| ВХОД ДЛЯ ПАЦИЕНТОВ
|Re: Pelvic binder in fracture pelvis
послал Milton L. Routt 15 Апрель 2009, 22:09
|We use circumferential sheets positioned and adjusted for each patient’s pelvic ring injury...if a frame is indicated for the specific pelvic injury pattern and the reduction is excellent in the sheet, then holes are cut in the sheet to allow for pin insertions and frame application-assembly before the sheet is then removed....iliosacral screws can similarly be inserted using the sheet’s “working portals” when the reductions are valid.
Commercial binders are expensive and not always available....so we use sheets.
Acute pelvic frame use as a resuscitation adjunct is very rare in our institution.
Posterior pelvic C-clamps or other such posterior pelvic external devices are not used....instead, iliosacral screws are used.
But some physicians sell binders and therefore recommend them...others use them because they are attracted to such medical gear...some like binders because they are marketed very well in the USA...binders just seem like a huge waste of money to me.
Frames are difficult to apply unless you are familiar with them...many pins are mis-inserted, some not even in bone...the pin site incisions often are extensive and can negatively affect potential surgical sites...over the years, it’s become obvious to me that pelvic frame application in acute clinical situations is unpredictable and random, at best.
Many physicians are now tinkering around with low anterior pelvic frames applied using pins inserted at the AIIS and along the pelvic brim above the acetabulum...these frames were initially popular in the late-80s (maybe even before then) and have made a recent comeback under the guise of their “power and strength”...as people have grown more obese, manufacturers have made very long pins so now we can use these again if we choose to...they are quite effective for pelvic manipulative reductions in the OR while internal fixation is assembled around them...but definitively (despite some small series advocating them) we’ve seen hip infections from these pins, the low pins also obstruct medullary ramus screw use, and if inserted deeply they will obstruct even routine iliosacral screw use...most low frame patients have a very difficult time trying to sit or move around with such frames in their anterior hip regions...they are deeper from skin to bone so the dripping is as expected...some physicians even use them after anterior iliac exposures with resultant deep iliac abscess formation...symptomatic ectopic bone formation is also common around the AIIS pins.
I like the low frames best as an operative manipulative device, and occasionally as an “activity restrictor” if we anticipate significant non-compliant behaviour from our patient.
Maybe that’s what we wrote before...I didn’t read the old discussion...so if this is the same as back when, then we’re at least consistent!!!!!!!
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