Page 42 - Journal of Special Operations Medicine - Winter 2014

Figure 3 Volumetric Figure 4 Technique of
three-dimensional volume measurement
rendering of is made on a three-
anteroposterior (AP) dimensional rendering
view of pelvis after of an AP view after
simulated disruption JETT placement.
and injury.

injury with additional complication of inferior and su- displaced injury segments in both cadavers. No addi-
perior rami fractures, such as those commonly seen in tional manual manipulation was necessary. The circum-
dismounted complex blast injuries. External rotation ferential compression of the pelvic soft tissue envelope
6
forces were manually applied to each iliac wing to later- with the JETT strap was an efficient means to achieve
ally displace the iliac wings and separate the disruption a controlled reduction of the externally rotated APC III
and injury sites at the sacroiliac joint and the pubis sym- injury. CT scans demonstrated that the JETT applica-
physis to the maximum extent possible. A CT scan of tion effectively induced circumferential soft tissue com-
the pelvis was repeated to measure the simulated injury pression which evoked near anatomic reduction of the
and displacement at its maximal separation. sacroiliac joint and symphysis pubis (Figures 4, 5A, and
6) while allowing compression of the vascular structures
An attending emergency physician (formerly a Fleet Ma- at the ideal location (Figure 5B).
rine Force Corpsman) and an attending orthopedic trau-
matologist then each placed the JETT according to the Figure 5 (A) Three-dimensional volumetric bony rendering
manufacturer’s instructions for junctional hemorrhage of pelvic disruption with compression pads of the junctional
control. Alignment of the device with anatomical land- tourniquet over the bilateral superior rami. (B) Three-
marks was evaluated by visual and tactile means. dimensional volumetric soft tissue rendering of compression
pads of the junctional tourniquet over soft tissues superficial
to the inguinal canal.
Post-JETT Radiography
Volumetric data of the skeletal pelvis were collected (A) (B)
using a single measurement of bony landmarks. Three-
dimensional correction was made with Osirix 64-bit
software (Pixmeo, Berne, Switzerland) (Figure 4). All
CT scans were evaluated by a fellowship-trained mus-
culoskeletal radiologist. The predisruption measure-
ments were compared with post-JETT measurements at
the same pelvis inlet and outlet levels. Reduction of the
pelvic inlet and outlet diameters back toward normal,
predisruption levels were used to quantify the adequacy
of reduction; that is, the difference of the measurements Figure 6 CT images of unstable APC III disruption and
was the degree of reduction. Positive values of the differ- injury obtained in two transverse planes before and after
ences in the measurements indicated partial reduction in application of JETT.
that the deformity correction was incomplete. Negative
numbers represented overcorrection of the deformity by
the JETT device.

Results
In order to achieve optimal compression pad place-
ment over the common femoral artery, the JETT waist
band is ideally centered to circumscribe the symphy-
sis pubis and greater trochanteric region. Application
of the JETT as per the manufacturer’s instructions for
hemorrhage control to the disrupted and injured pelvis
resulted in a rapid and stable reduction of the widely

32 Journal of Special Operations Medicine Volume 14, Edition 4/Winter 2014