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Scientific Articles   |    
Comparison of Three Different Pelvic Circumferential Compression Devices: A Biomechanical Cadaver Study
S.P. Knops, MSc1; N.W.L. Schep, MD, PhD, MSc1; C.W. Spoor, PhD1; M.P.J.M. van Riel, MSc1; W.R. Spanjersberg, MD1; G.J. Kleinrensink, PhD1; E.M.M. van Lieshout, PhD1; P. Patka, MD, PhD1; I.B. Schipper, MD, PhD1
1 Departments of Surgery-Traumatology (S.P.K., N.W.L.S., W.R.S., E.M.M.v.L., P.P., and I.B.S.) and Neurosciences and Anatomy (C.W.S., M.P.J.M.v.R., and G.J.K.), Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. E-mail address for E.M.M. van Lieshout: e.vanlieshout@erasmusmc.nl
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Feb 02;93(3):230-240. doi: 10.2106/JBJS.J.00084
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Abstract

Background: 

Pelvic circumferential compression devices are designed to stabilize the pelvic ring and reduce the volume of the pelvis following trauma. It is uncertain whether pelvic circumferential compression devices can be safely applied for all types of pelvic fractures because the effects of the devices on the reduction of fracture fragments are unknown. The aim of this study was to compare the effects of circumferential compression devices on the dynamic realignment and final reduction of the pelvic fractures as a measure of the quality of reduction.

Methods: 

Three circumferential compression devices were evaluated: the Pelvic Binder, the SAM Sling, and the T-POD. In sixteen cadavers, four fracture types were generated according to the Tile classification system. Infrared retroreflective markers were fixed in the different fracture fragments of each pelvis. The circumferential compression device was applied sequentially in a randomized order with gradually increasing forces applied. Fracture fragment movement was studied with use of a three-dimensional infrared video system. Dynamic realignment and final reduction of the fracture fragments during closure of the circumferential compression devices were determined. A factorial repeated-measures analysis of variance with pairwise post hoc comparisons was performed to analyze the differences in pulling force between the circumferential compression devices.

Results: 

In the partially stable and unstable (Tile type-B and C) pelvic fractures, all circumferential compression devices accomplished closure of the pelvic ring and consequently reduced the pelvic volume. No adverse fracture displacement (>5 mm) was observed in these fracture types. The required pulling force to attain complete reduction at the symphysis pubis varied substantially among the three different circumferential compression devices, with a mean (and standard error of the mean) of 43 ± 7 N for the T-POD, 60 ± 9 N for the Pelvic Binder, and 112 ± 10 N for the SAM Sling.

Conclusions: 

The Pelvic Binder, SAM Sling, and T-POD provided sufficient reduction in partially stable and unstable (Tile type-B1 and C) pelvic fractures. No undesirable overreduction was noted. The pulling force that was needed to attain complete reduction of the fracture parts varied significantly among the three devices, with the T-POD requiring the lowest pulling force for fracture reduction.

Clinical Relevance: 

The results of this biomechanical cadaver study suggest that circumferential compression devices can provide early, noninvasive circumferential compression in partially stable and unstable pelvic fractures for advantageous realignment and reduction of these fractures without overreduction. Clinical effectiveness of circumferential compression devices in patients with pelvic ring fractures remains to be determined.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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