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Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures

European Journal of Trauma and Emergency Surgery volume 44, pages 747–752 (2018)Cite this article

Abstract

Background

Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine.

Methods

We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures. Data were collected anonymously via a standardized case report.

Results

A total of 254 patients with suspected pelvic injuries from 12 different trauma centers were included in this study. In 95 out of 254 cases a per definition unstable pelvic fracture could be confirmed; 46 type B and 49 type C fractures was confirmed. Mechanical stability examination was carried out in 61% and revealed a sensitivity of 31.6% and a specificity of 92.2%. 11.5% (18 patients) actually showed a mechanical instability (6 B# 12 C#). Regardless, 166 patients (65.4%) received noninvasive external stabilization ahead of diagnostic imaging, as a result of clinical judgment. 72% (24×) showed signs of significant bleeding in the subsequent CT scans. 33 pelvic ring fractures (type B or C) had no prehospital stabilization.

Conclusion

Testing of mechanical stability of the pelvic ring was carried out less often and with lower consequences for the actual management than expected. It seems worthwhile to rather put on a pelvic binder at earliest occasion based on trauma mechanism or clinical findings to reduce the risk of serious pelvic bleeding.

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Author information

Affiliations

  1. Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany

    Uwe Schweigkofler, B. Wohlrath, N. Tamimi, R. Hoffmann & D. Wincheringer

  2. Institut für Notfallmedizin und Medizinmanagement, Schillerstr 53, 80336, Munich, Germany

    H. Trentsch

  3. Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscherstr.8, 82418, Murnau, Germany

    J. Greipel

Authors
  1. Uwe Schweigkofler
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  2. B. Wohlrath
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  3. H. Trentsch
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  4. J. Greipel
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  5. N. Tamimi
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  6. R. Hoffmann
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  7. D. Wincheringer
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Corresponding author

Correspondence to Uwe Schweigkofler.

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Conflict of interest

All authors (Schweigkofler, Wohlrath, Trentzsch, Greipel, Tamimi, Hoffmann and Wincheringer) declare no conflict of interest.

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Schweigkofler, U., Wohlrath, B., Trentsch, H. et al. Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. Eur J Trauma Emerg Surg 44, 747–752 (2018). https://doi.org/10.1007/s00068-017-0860-0

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  • DOI: https://doi.org/10.1007/s00068-017-0860-0

Keywords

  • Pelvic ring fracture
  • Pelvic binder
  • Pelvic ring stabilization
  • Prehospital management
  • Emergency room treatment