Damage Control Stabilization of the pelvis in patients “in extremis”

Introduction: Immediate posterior pelvic ring stabilization is the prerequisite for pelvic packing. In patients “in extremis”, often no adequate positioning or imaging is available. Percutaneous application of a stabilizing K-wire or even a screw at the posterior pelvic ring can give adequate stability without an increased risk damage to surrounding structures, when respecting classical landmarks. Materials and Methods In 10 human adult whole-body cadavers, a percutaneous application of a 2.8mm K-wire was performed with only an a.p. image intensifier x-ray available. The classical entry point for iliosacral screw fixation was used. Control imaging, including a.p., Inlet and Outlet views confirmed the position of the K-wire using an Arcadis© Orbic 3D C-arm (SIEMES; Solothum, Switzerland). Results In 16 of 20 hemipelves (80%), in all three standard radiographic planes, the K-wire was in the expected anatomic position. Malposition was observed as usually too anterior positioning of the wire in relation to the sacrum. Conclusions Using standard landmarks, percutaneous application of K-wires into the posterior pelvic ring using only a.p. x-rays was found to be safe with few mal-placements. The complication rate is comparable to mal-placement of pelvic C-clamp pins. This technique is feasible in patients in extremis.