Fixator for the pelvis beyond the body: Its purpose, applications, potential drawbacks, advantages, and further details
In the realm of orthopaedic surgery, an external pelvic fixator plays a crucial role in treating unstable pelvic fractures, particularly in cases where patients cannot tolerate more complex, lengthy procedures. This minimally invasive procedure, performed through small incisions, provides temporary stabilisation until a more definitive surgery can be carried out.
The pelvic external fixator is often a temporary measure used to repair fractures resulting from major trauma to the pelvic bone. Causes of such trauma may include motorcycle or motor vehicle accidents, accidents involving pedestrians and motor vehicles, crush injuries, and falls from a significant height.
Dr. Snow, a renowned orthopaedic surgeon, emphasises the importance of using the pelvic external fixator within hours of injury in the operating room. This early intervention can help close down the potential space for bleeding, thereby reducing the need for blood transfusions and potentially increasing survival rates.
However, the long-term recovery implications and potential complications of this surgery are significant. Recovery can be protracted, often taking several months, and may require extensive physical therapy and multidisciplinary care for optimal functional outcome.
Potential complications include extended rehabilitation time, risk of infection, potential nerve or vascular injury, chronic pain, mobility limitations, and the possibility of nonunion or malunion of the fracture. Infection at the pin sites of the external fixator is a common risk due to the percutaneous hardware. Nerve injury, such as sciatic nerve damage, can occur but may show functional recovery within months post-surgery. Nonunion or malunion if the fixation is insufficient or if rehabilitation is inadequate, potentially resulting in deformity or post-traumatic arthritis, is another concern. Chronic pain and pelvic floor dysfunction may persist, particularly in cases involving childbirth or associated soft tissue damage.
Severe cases, especially open pelvic fractures, often require staged surgical interventions, prolonged hospitalization, and comprehensive care coordination, including wound management, infection control, and rehabilitation services.
Advances in fixation techniques, including external fixation, aim to improve stability and reduce complications, with earlier mobilization contributing to better functional recovery. However, complications such as implant failure, delayed healing, or requirement for revision surgery may still occur.
An alternative treatment to a pelvic external fixator is a pelvic binder, a strap used to compress the pelvic area. However, pelvic binders can cause pressure sores if left on too long and are not an option if someone needs general abdominal surgery to address an injury.
In summary, while external pelvic fixators provide critical stabilization for pelvic fractures, long-term recovery may involve challenges related to infection control, nerve and soft tissue injury, prolonged rehabilitation, and functional impairments requiring multidisciplinary care. A 2020 study has shown that external pelvic fixator surgery can control bleeding, reduce the need for blood transfusions, and improve a person's outlook.
- Blood transfusions might be necessary in cases where the pelvic external fixator intervention isn't performed early enough, due to potential bleeding.
- Recovery from pelvic fractures treated with external fixators can be prolonged, often spanning several months, and may necessitate extensive medical-condition management such as physical therapy and multidisciplinary care for optimal health-and-wellness outcomes.
- Chronic conditions like chronic pain, mobility limitations, and pelvic floor dysfunction can persist even after treatment for pelvic fractures, particularly in cases involving childbirth or associated soft tissue damage.
- Science and medicine continue to advance with the aim of improving fixation techniques like external fixation to provide better stability, reduce complications, and promote healthier, quicker functional recovery for patients with pelvic fractures, accident and falls-related injuries, and chronic diseases.
