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Subcutaneous Internal-External Fixation for Pelvic Fracture Fixation: A Novel Approach for Open Fracture FixationA Case Report
CPT Elizabeth M. Polfer, MD1; CPT Matthew W. Kluk, MD1; MAJ Korboi N. Evans, MD1; LTC Wade T. Gordon, MD1; COL Romney C. Andersen, MD1
1 Orthopaedic Surgery Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889. E-mail address for K.N. Evans: korboi.evans@us.army.mil
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Orthopaedic Surgery Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889. E-mail address for K.N. Evans: korboi.evans@us.army.mil
Investigation performed at Walter Reed National Military Medical Center, Bethesda, Maryland
Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, the Department of the Navy, Department of Defense, nor the U.S. Government. We are military service members (or employees of the U.S. Government). This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

JBJS Case Connector, 2012 Jun 13;2(2):e24 1-4. doi: 10.2106/JBJS.CC.K.00100
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Extract

Pelvic fractures account for 1.5% to 3% of all fractures1,2. A majority of these fractures are from low-energy mechanisms, such as a fall from standing height in elderly, osteoporotic patients. In younger patients, pelvic fractures are often the result of high-energy trauma. Of all pelvic fractures, 0.1% to 4% are open fractures1-5. Up to 72% of these represent a Gustilo-Anderson Type-III fracture caused by the large amount of force needed to penetrate the soft-tissue envelope around the pelvis6. Open fractures of the pelvic ring have been described as occurring in one of three zones: zone I, which encompasses the perineum; zone II, which encompasses the medial thigh or groin; or zone III, which encompasses the posterolateral buttock2. Open fractures associated with perineal injuries are associated with a higher mortality given the extent of injury and risk for infection. Closed fractures have a substantially lower mortality rate of 10.5%, compared with a mortality rate of up to 50% with open fractures3. The higher rate of mortality is caused by hemorrhage, associated injuries, and sepsis2,4. We present a patient with an anteroposterior compression type-II (APC-II) pelvic fracture with substantial gluteal/perineal wounds, who was treated with an anterior subcutaneous external fixator facilitating prone positioning during multiple surgical debridements. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
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    Accreditation Statement
    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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