Orthopaedic Surgery

Answer 4 Head injury. Pelvic fracture bleeding may be treated with external fixation during the resuscitation of the bleeding trauma patient. Although somewhat controversial, external fixation is believed to achieve bony stabilization, which decreases the motion of fracture surfaces on themselves and allows clots to form, and reduction of pelvic volume, which allows early tamponade of venous bleeding. Stable fractures do not benefit from external fixation because the fracture surfaces are not moving and pelvic volume is not increased. External fixation is contraindicated with a floating iliac wing because a floating iliac wing does not allow control of the hemipelvis with the fixator. An ipsilateral acetabular fracture is a relative contraindication to external fixation because future incisions for acetabular surgery may be compromised by existing pin sites. Arterial bleeding is poorly controlled by external fixation and is better addressed with angiographic embolization. Head injury presents no contraindication to external fixation, which should be viewed as part of the resuscitation. Click here to return to the questions

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