Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria.
Department for Trauma Acute Surgery Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
Arch Orthop Trauma Surg. 2024 Oct;144(10):4577-4586. doi: 10.1007/s00402-024-05555-4. Epub 2024 Sep 23.
Combined injuries of the pelvic ring and the acetabulum are uncommon. Acute treatment should follow common protocols (ATLS e.g.) for pelvic ring injuries, although mechanical stabilization using pelvic binders or external fixators might be insufficient or even worsen the reduction in some combined fracture patterns. In case of mechanically connected acetabular and pelvic ring injury (MCAPI), surgical treatment might be demanding in lack of clear recommendations concerning the reduction and fixation sequence. A "pelvic ring first" sequence may be the best choice for most MCAPIs, starting with sacrum or SI-joint and symphysis pubis. An "acetabulum first" sequence should be considered in relatively stable posterior ring injuries and acetabulum fractures in younger patients, where a perfect anatomical reduction is feasible. Definitive surgical treatment should be performed as soon as possible depending on concomitant injuries, ideally within 3-7 days. Mechanical understanding of the combined fracture pattern and accurate planning are mandatory for surgical repair.
骨盆环和髋臼的联合损伤并不常见。急性治疗应遵循骨盆环损伤的一般方案（例如 ATLS），尽管使用骨盆束带或外固定器进行机械稳定可能不足，甚至在某些联合骨折模式下会加重复位不良。在机械连接的髋臼和骨盆环损伤（MCAPI）的情况下，如果缺乏关于复位和固定顺序的明确建议，手术治疗可能具有挑战性。对于大多数 MCAPI，“骨盆环优先”的序列可能是最佳选择，从骶骨或 SI 关节和耻骨联合开始。对于相对稳定的后环损伤和年轻患者的髋臼骨折，应考虑“髋臼优先”的序列，在这些情况下可以实现完美的解剖复位。根据伴随损伤，应尽快进行确定性手术治疗，理想情况下在 3-7 天内。对于手术修复，必须对联合骨折模式有机械上的理解和准确的规划。
