Use of antishock iliosacral screw technique in a polytraumatized patient in extremis: A case report

Abstract

Introduction: Patients in extremis or with hemodynamically unstable pelvic ring fractures require a multidisciplinary approach to control bleeding promptly using internal and/or external fixation methods.

Case presentation: A 53-year-old man was admitted to the emergency department of a tertiary care clinic in Chía (Colombia) following a traffic accident. On admission, pelvic instability, mild cranioencephalic trauma, complete rupture of the patellar tendon and anterior and posterior cruciate ligaments, and open knee dislocation were observed. Deterioration of the respiratory pattern and hemorrhagic shock occurred while he was being treated in the resuscitation room. Computed tomography scans revealed an unstable fracture of the pelvic ring, incomplete fracture of the ischiopubic ramus, and fracture of the ipsilateral femoral neck. The patient experienced a hemodynamic collapse and was classified as polytraumatized in extremis. Consequently, he was taken to damage control surgery, where pelvic packing was performed and an external supra-acetabular fixator was placed, resulting in an insufficient reduction. Due to persistent hemodynamic instability, antishock iliosacral screw (AIS) technique was implemented and knee dislocation was reduced. Four weeks later, he underwent definitive pelvic ring fixation. Despite his critical clinical condition, hemodynamic stabilization and successful recovery were achieved. He was discharged several months after the initial therapy.

Conclusion: The AIS technique is an emergency strategy that can be used in patients with unstable pelvic fractures that do not respond to other damage control methods.