Abstract
Pelvic fractures account approximately for 3 % of all skeletal injuries. About 10 % of pelvic fractures may be classified as “complex,” characterized by mechanical and/or hemodynamic instability. The mortality of patients with hemodynamically unstable pelvic fractures has been reported between 40 and 60 %. According to the mechanism of trauma, pelvic fracture patterns are classified into four types: anterior-posterior compression (APC), lateral compression (LC), vertical shear (VS), and combined types. All patients with suspected unstable pelvic fracture should be managed by a multidisciplinary team. The main goals of initial management are to identify pelvic fracture pattern, to achieve bleeding control, to identify associated life-threatening extrapelvic injuries. The hemodynamic response of the patient after initial resuscitative measures indicates the following decision-making. On physical exam, direct and indirect signs of pelvic fracture need to be addressed. The pelvis radiogram highlights the fracture pattern, its degree of biomechanic instability, and the associated risk of hemodynamic derangement, the right maneuvers to be performed in order to obtain the best fracture reduction and bleeding control. E-FAST may detect the presence of abdominal free fluid. Pelvic binders are the best way to quickly achieve bleeding control. External fixators are positioned after POD to take care more effectively of the initial hemodynamic instability. Preperitoneal pelvic packing (PPP), in association with EF, is a damage control technique that may “bridge” the patient to other diagnostic and therapeutic procedures. Angiography must be considered as a part of the ongoing resuscitative efforts during damage control strategy. In case of complex pelvic fractures, the presence of associated intra-abdominal organ injuries has to be addressed.
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References
Gansslen A, Giannoudis P, Pape HC (2003) Hemorrhage in pelvic fracture: who needs angiography? Curr Opin Crit Care 9(6):515–523
De Moraes Cordts Filho R, Parreira JG, Giannini Perlingeiro JA et al (2011) Pelvic fractures as a marker of injury severity in trauma patients. Rev Col Bras Cir 38(5):310–315
Balogh Z, King KL, Mackay P et al (2007) The epidemiology of pelvic ring fractures: a population based study. J Trauma 63(5):1066–1072; discussion 1072–1073
Hauschild O, Strohm PC, Culemann U et al (2008) Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma 64(2):449–455
Cullinane DC, Schiller HJ, Zielinski MD et al (2004) Eastern Association for the Surgery of Trauma Practice Management Guidelines for hemorrhage in pelvic fracture-update and systematic review. J Trauma 71(6):1850–1868
Smith W, Williams A, Agudelo J et al (2007) Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma 21:31–37
Sathy AK, Starr AJ, Smith WR et al (2009) The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am 91:2803–2810
Metcalfe AJ, Davies K, Ramesh B et al (2011) Haemorrhage control in pelvic fractures-A survey of surgical capabilities. Injury 42:1008–1011
Kataoka Y, Maekawa K, Nishimaki H et al (2005) Iliac vein injuries in hemodynamically unstable patients with pelvic fractures caused by blunt trauma. J Trauma 58:704–708; discussion 708–710
Smith K, Ben-Menachem Y, Duke JH Jr et al (1976) The superior gluteal: an artery at risk in blunt pelvic trauma. J Trauma 16:273–279
Burgess AR, Eastridge BJ, Young JW et al (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30:848–856
American College of Surgeons (2008) Advanced trauma life support course. Student manual, 8th edn. American College of Surgeons, Chicago
Rucholtz S, Waydhas C, Lewan U et al (2004) Free abdominal fluid on ultrasound in unstable pelvic ring fracture: is laparotomy always necessary? J Trauma 57:278–285
White CE, Hsu JR, Holcomb JB (2009) Haemodynamically unstable pelvic fractures. Injury 40:1023–1030
Durkin A, Sagi HC, Durham R et al (2006) Contemporary management of pelvic fractures. Am J Surg 192:211–223
Ghaemmaghami V, Sperry J, Gunst M et al (2007) Effect of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures. Am J Surg 194:720–723
Trikha V, Gupta H (2011) Current management of pelvic fractures. J Clin Orthop Trauma 2(1):12–18
Spanjersberg WR, Knops SP, Schep NW et al (2009) Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures. A systematic review of the literature. Injury 40:1031–1035, Epub 2009 Jul 17
Giannoudis PV, Pape HC (2004) Damage control orthopaedics in unstable pelvic ring injuries. Injury 35:671–677
Dyer GS, Vrahas MS (2006) Review of the pathophysiology and acute management of haemorrhage in pelvic fracture. Injury 37:602–613
Cothren CC, Osborn PM, Moore EE et al (2007) Preperitoneal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma 62:834–842
Suzuki T, Smith WR, Moore EE (2009) Pelvic packing or angiography: competitive or complementary? Injury 40:343–353
Bach A, Bendix J, Hougaard K et al (2008) Retroperitoneal packing as part of damage control surgery in a Danish trauma centre-fast, effective, and cost-effective. Scand J Trauma Resusc Emerg Med 16:4–7
Niola R, Pinto A, Sparano A et al (2012) Arterial bleeding in pelvic trauma: priorities in angiographic embolization. Curr Prob Diagn Radiol 41:93–101
Agolini SF, Shah K, Jaffe J et al (1997) Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage for controlling pelvic fracture hemorrhage. J Trauma 43:395–399
Burlew CC, Moore EE, Smith WR et al (2011) Pre-peritoneal pelvic packing/External Fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J Am Coll Surg 212:628–637
Chiara O, Castelli F (2012) Trauma complesso della pelvi. In: Chiara O, Nardi G, Gordini G, Sandon G (eds) Trauma care. Elsevier, Masson, pp 265–277
Lunsjo K, Fikri MAZ (2006) Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma 60:1145–1148
Kudsk KA, Hanna KM (2003) Management of complex perineal injuries. World J Surg 27:895–900
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Cimbanassi, S., Chiara, O. (2014). Pelvic Damage Control. In: Di Saverio, S., Tugnoli, G., Catena, F., Ansaloni, L., Naidoo, N. (eds) Trauma Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5459-2_5
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