Fractures of the Pelvis and Acetabulum PDF

Preface

Fractures of the pelvis and acetabulum are among the most challenging injuries to treat in orthopaedic surgery. Pelvic injuries continue to have a high acute mortality and cause severe long-term disability. Tremendous improvements in prehospital resuscitation and transfer of injured patients have brought many patients to the hospital who previously would have died in the field. The trauma team is challenged to maintain blood pressure in these patients by stopping pelvic hemorrhage and limiting systemic damage. If resuscitation of these patients is successful, the next challenge is to reconstruct high energy injuries often with concomitant nerve and articular damage. The overall severity of pelvis fractures undergoing reconstruction is likely to increase given that highly comminuted fracture patients are surviving. It may be said that the pelvis that used to die now needs "fixing," and our standard techniques may not be suitable for these highly complex injuries.

Once reconstruction occurs, the next challenge is rehabilitation of the injured patient. Surgeons have become increasingly aware that outcome is not simply an x-ray finding, or even a score on a validated scale. Outcome for the patient with pelvic and acetabular injuries is a complex analysis that comes down to the basics of life for many patients. Posttraumatic arthrosis, chronic pain, nerve damage, and bowel, bladder, and sexual dysfunction, intertwined with psychological distress are the real challenges to the patient. No matter how heroic the initial work and salvage of the patient's life, ultimately the quality of life becomes the sine qua non of a "good" result. While many centers are working diligently to improve the acute outcome of pelvic fracture patients and fixation techniques for the pelvis and acetabulum, the time has come to apply the same energy toward improvements in post-injury rehabilitation. The interface of the patient, the surgeon, the rehabilitation specialist, and society may be the next frontier in the management of pelvic and acetabular injuries.

In consideration of the preceding surmises, this book aims to cover the basics of pelvic and acetabular injuries, but also expose the reader to the detailed, practical experience of surgeons who are dealing with these complex injuries every day. The variety of authors is intentional to provide wide exposure to the gamut of philosophies and techniques. No matter the continent or the country, there are good surgeons working hard to obtain the best results possible for their patients. Our hope is that you, the reader, will find within these pages some measure of information or, better yet, inspiration to help you in your efforts.