Pelvic and Acetabular Fracture Management Essentials

Welcome and Introduction

Speakers: Dr. Steven Sims, Dr. Marc Riley, Dr. David Stephen
Course Concept: Born out of the COVID-19 pandemic
Course Format: Internet-based, blended with potential face-to-face session in January (cadaver session in Las Vegas)
Credits: CME credit available for live sessions
YouTube Resource: AO Trauma North America channel for additional videos
Schedule: 8 successive Saturday mornings, each session 90 minutes
First Session: July 11th
Topics Covered: Pelvis, acetabular fractures, expert panels, special problems
Engagement: Use Q&A tab for questions, review talks via video, prepare by watching videos for upcoming sessions
Open Mind: Different treatment methods

Today's Topics: Radiographic evaluation, emergency management, percutaneous techniques
Learning Objectives: Initial evaluation, radiology and classification, treatment techniques, percutaneous fixation
Speakers Today: Dr. Mark Adams, Dr. Hans Kreuter, Dr. Chip Routt

Quality Radiographs: Visualize bony structures, relationships with neurovascular structures, identify associated injuries
Classifications: Tile AO, Young and Burgess, AO/OTA
Pelvic Radiographs: AP pelvis, outlet view, inlet view
Dysmorphic Sacrum: Difference between normal and dysmorphic sacrum, implications for trans sacral screws
Study Normal Anatomy: Understand the skeleton, muscular, neurologic, and vascular anatomy
Initial Evaluation: Examine for external and internal bleeding, pack open wounds, immobilize pelvis
Identify Pelvis at Risk: Physical exam, check for pelvis movement, hematomas
Imaging: AP pelvis, inlet/outlet views, CT scans
Emergency Fixation: Options include C-clamp, external fixator, resuscitation screws
Reassessment: Continuous evaluation for ongoing bleeding

Tile Classification: Stability-based (A: stable, B: rotationally unstable, C: rotationally and vertically unstable)
Young and Burgess: Mechanism of injury (APC, LC, VS)
AO/OTA Classification: Anatomic approach, stability, deformity
Examples: APC 1, APC 2, LC 1, LC 2, VS

Role of Trauma Surgeon: Part of team, perform emergency assessment, control hemorrhage, stabilize pelvis
Initial Steps: Assess for pelvic bleeding, immobilize pelvis, reassess continuously
Types of Bleeding: External and internal, focus on internal due to pelvic ring injuries
Stabilization Techniques: Sheets, binders, external fixators, C-clamps
Advanced Techniques: Resuscitation screws, pelvic packing, REBOA
Approach to Hemorrhage: Identify bleeding sources, control with appropriate techniques

Historical Evolution: From open reduction to percutaneous fixation
Indications: Posterior pelvic ring injuries, sacral fractures, sacroiliac joint injuries, pediatric cases, resuscitation phase
Contraindications: Inability to achieve reduction, significant soft tissue issues, debris in tunnels
Osseous Fixation Pathways: Normal and dysmorphic sacrum, planning and execution
Radiographic Views: Inlet, outlet, lateral views
Techniques: Utilize osteology and fluoroscopy, ensure precise planning and execution
Case Example: 38-year-old female, reduction and percutaneous fixation plan, intraoperative adjustments
Final Notes: Importance of accurate preoperative planning, intraoperative radiology, post-operative critique

Understand normal and dysmorphic pelvic anatomy
Initial evaluation of pelvic injuries involves physical examination and imaging
Stabilize patients with pelvic injuries using various techniques
Classifications help guide treatment and predict associated injuries
Percutaneous fixation requires careful planning, understanding of osseous pathways, and precise execution

Next Week: Focus on definitive fixation of pelvic ring injuries, open reduction techniques
Homework: Watch assigned videos on YouTube channel for preparation
CME Credit: Available upon course evaluation and review