Page 20 - XM-PHK-Mobile

CliniCAl APPliCAtions & exPerienCe 20 Femoral and pelvic fractures are frequently associated in patients with multiple injuries and the conventional surgical procedure involves the use of a traction table using a perineal post to allow traction of the lower limb. However, this type of procedure is very difficult to perform without complications such as displacement of the pubic rami or injuries to pelvic soft tissues, which are sometimes already damaged from the trauma. We were looking for a solution to minimize such crippling complications and to guarantee an optimal external reduction and internal fixation at the same time. The Pink Hip Kit® has been the answer and we reviewed our initial experience of femoral fractures associated with pelvic fractures successfully treated with a postless traction technique. In patients with multiple injuries, pelvic ring injuries are the most serious skeletal fractures and they are responsible for high rates of neurologic, gynecologic and urogenital complications1,2. Vaginal tears and scrotal necrosis are common as well as bladder and Alessandro Aprato, M.D.* urethral perforation3,4. Some of them are described by patients as very disabling: pudendal nerve injuries may lead to urinary and fecal continence disorders, to chronic pain in the lesser pelvic region, to issues of sexual function disorders. When pelvic ring fractures are associated with femoral fractures, internal fixation is usually performed with a standard traction table using a perineal post which often increases these pelvic problems 5. Used for hip arthroscopy, the postless distraction technique has never been described in trauma patients. In elective cases, its safety and efficacy has already been described in two published papers 6, 7 so we decided to use a shape-conforming pad which prevents patient movement (The Pink Hip Kit®; Xodus Medical) to obtain an adequate distraction of the femoral fracture in five patients with multiple injuries who also have a pelvic ring injury. All patients have undergone a damage control surgery and, where indicated, a stabilization with temporary external fixators. Fractures were fixed with intramedullary nails. Patients were treated in general anesthesia. Surgeries were performed in the supine position on a traction table without a post. Patients were placed on a commercially Postless Hip Distraction for Combined Femoral and Pelvic Fractures: A New Technique. *University of Turin, Turin, Italy