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Komplexverletzung des Beckens

Complex pelvic injury

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Komplexverletzungen stellen hohe Ansprüche an Logistik, Behandler und Management. Trotz immenser Fortschritte in diesen Bereichen ist die komplexe Beckenverletzung (Frakturen des Beckenrings oder selten des Azetabulums mit Beteiligung der Weichteile) nach wie vor mit einer hohen Mortalität behaftet, vorwiegend aufgrund von Blutungen bzw. Sepsis. Durch standardisierte Vorgehensweisen (Algorithmen) lässt sich die schlechte Prognose dieser Verletzungen jedoch verbessern. Da meist erhebliche Energieeinwirkungen zugrunde liegen, ist die Anamneseerhebung bereits ein wichtiger Baustein der Versorgung. Nach klinischer Untersuchung folgen Ultraschalluntersuchung, die die Weiche zwischen Notfalloperation oder weiterer Diagnostik stellt, radiologische Basisdiagnostik und Spiral-CT. Nach der Akutversorgung ist das Zeitmanagement der Versorgung entscheidend: Nach primär großzügigem Débridement und Lavage sind häufig wiederkehrende Revisionen zur Reduktion nekrotischen Gewebes und damit Vermeidung einer Sepsis notwendig.

Abstract

Complex injuries constitute a great challenge to logistics, attending physicians, and management. Despite immense advances in these areas, the complex pelvic injury (fractures of the pelvic ring or rarely of the acetabulum with soft tissue involvement) remains associated with a high mortality rate, mostly as a result of hemorrhages or sepsis. The poor prognosis of these injuries can be improved, however, by adhering to standardized procedures (algorithms). Since the underlying causes are predominantly considerable energy effects, medical history taking is an important element for treatment. The clinical examination is followed by ultrasound scan, which indicates whether the next step should be emergency surgery or further diagnostic testing, radiological basic diagnostics, and spiral CT. After provision of acute care, time management of medical care is decisive: after primary extensive débridement and lavage, repeated revisions to reduce necrotic tissue and thus to avoid sepsis are often necessary.

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Literatur

  1. Aihara R, Blansfield JS, Millham FH et al. (2002) Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. J Trauma 52: 205–208

    PubMed  Google Scholar 

  2. Balogh Z, King KL, Mackay P et al. (2007) The epidemiology of pelvic ring fractures. A population-based study. J Trauma 63: 1066–1073

    Article  PubMed  Google Scholar 

  3. Barbagli G, Selli C, Stomaci N et al. (1987) Urethral trauma: radiological aspects and treatment options. J Trauma 27: 256–261

    PubMed  CAS  Google Scholar 

  4. Bigongiari LR (1994) Traumatic, inflammatory, neoplastic and miscellaneous lesions of the bladder. In: Land EK (ed) Radiology of the lower urinary tract (medical radiology). Springer, Berlin Heidelberg New York

  5. Bosch U, Pohlemann T, Haas N et al. (1992) Klassifikation und Management des komplexen Beckentraumas. Unfallchirurg 95: 189 ff

    PubMed  CAS  Google Scholar 

  6. Carroll PR, McAninch JW (1983) Major bladder trauma: the accuracy of cystography. J Urol 130: 887–888

    PubMed  CAS  Google Scholar 

  7. Carroll PR, McAninch JW (1984) Major bladder trauma: mechanisms of injury and a unified method of diagnosis and repair. J Urol 132: 254

    PubMed  CAS  Google Scholar 

  8. Cass AS (1984) The multiple injured patient with bladder trauma. J Trauma 24: 731–734

    PubMed  CAS  Google Scholar 

  9. Cass AS (1989) Diagnostic studies in bladder rupture. Indications and techniques. Urol Clin North Am 16: 267–273

    PubMed  CAS  Google Scholar 

  10. Chiodo A (2007) Neurologic injury associated with pelvic trauma: radiology and electrodiagnosis evaluation and their relationships to pain and gait outcome. Arch Phys Med Rehabil 88: 1171–1176

    Article  PubMed  Google Scholar 

  11. Corriere JN (2001) 1-stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year follow up. J Urol 165: 404–407

    Article  PubMed  CAS  Google Scholar 

  12. Corriere JN, Sandler CM (1989) Management of extraperitoneal bladder rupture. Urol Clin North Am 16: 275–277

    PubMed  Google Scholar 

  13. Cothren CC, Osborn PM, Moore EE et al. (2007) Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma 62: 834–842

    PubMed  Google Scholar 

  14. Deck AJ, Shaves S, Talner L et al. (2000) Computerized tomography cystography for the diagnosis of traumatic bladder rupture. J Urol 164: 43–46

    Article  PubMed  CAS  Google Scholar 

  15. Doll D, Lenz S, Exadaktylos AK et al. (2006) Penetrierende Beckenverletzung. Chirurg 77: 770–780

    Article  PubMed  CAS  Google Scholar 

  16. Ertl W, Keel M, Eid K et al. (2001) Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 15: 468

    Article  Google Scholar 

  17. Friese RS, Malekzadeh S, Shafi S et al. (2007) Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. J Trauma 63: 97–102

    PubMed  Google Scholar 

  18. Gibson GR (1970) Impotence following fractured pelvis and ruptured urethra. Br J Urol 42: 86–88

    PubMed  CAS  Google Scholar 

  19. Isler B, Ganz R (1996) Classification of pelvic ring injuries. Injury [Suppl 1] 27:S-A3–12

  20. King J (1975) Impotence after fractures of the pelvis. J Bone Joint Surg Am 57: 1107–1109

    PubMed  CAS  Google Scholar 

  21. Koraitim MM, Marzouk ME, Atta MA et al. (1996) Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol 77: 876–880

    PubMed  CAS  Google Scholar 

  22. McAnich JW (1981) Traumatic injuries to the urethra. J Trauma 21: 291–297

    Google Scholar 

  23. Morell-Lavallé ■ (1948) Traumatismes fermes aux membres inferieurs. Hauquelin, Paris

  24. Morey AF, Hernandez J, McAninch JW et al. (1999) Reconstructive surgery for trauma of the lower urinary tract. Urol Clin North Am 26: 49–60

    Article  PubMed  CAS  Google Scholar 

  25. Morey AF, Iverson AJ, Swan A et al. (2001) Bladder rupture after blunt trauma: guidelines for diagnostic imaging. J Trauma 51: 683–686

    PubMed  CAS  Google Scholar 

  26. Morgan DE, Nallamala LK, Kenney PJ et al. (2000) CT cystography radiographic and clinical predictors of bladder rupture. AJR Am J Roentgenol 174: 89–95

    PubMed  CAS  Google Scholar 

  27. Perry MO, Husmann DA (1992) Urethral injuries in female subjects following pelvic fractures. J Urol 147: 139–143

    PubMed  CAS  Google Scholar 

  28. Pohlemann T, Culemann U, Gänsslen A et al. (1998) Die schwere Beckenverletzung mit pelviner Massenblutung: Ermittlung der Blutungsschwere und klinische Erfahrungen mit der Notfallstabilisierung. Unfallchirurg 99: 734 ff

    Article  Google Scholar 

  29. Pohlemann T, Gänsslen A, Stief CH (1998) Komplexe Verletzungen des Beckens und Acetabulums. Orthopäde 27: 32–44

    PubMed  CAS  Google Scholar 

  30. Pokorny M, Pontes JE, Pierce JM (1979) Urological injuries associated with pelvic trauma. J Urol 121: 455–457

    PubMed  CAS  Google Scholar 

  31. Reed MH (1976) Pelvic fractures in children. J Can Assoc Radiol 27: 255–261

    PubMed  CAS  Google Scholar 

  32. Rehm CG, Mure AJ, O’Malley KF et al. (1991) Blunt traumatic bladder rupture: the role of retrograde cystogramm. Ann Emerg Med 20: 845–847

    Article  PubMed  CAS  Google Scholar 

  33. Sagalowsky AI, Peters PC (1998) Genitourinary trauma. In: Walsh PC, Retik AB, Darracott VE et al. (eds) Campbell’s urology, 7th edn. Saunders, Philadelphia

  34. Sandler CM, Goldman SM, Kawashima A (1998) Lower urinary tract trauma. World J Urol 16: 69–75

    Article  PubMed  CAS  Google Scholar 

  35. Sevitt S (1968) Fatal road accidents. Injuries, complications and causes of death in 250 subjects. Br J Surg 55: 481–505

    Article  PubMed  CAS  Google Scholar 

  36. Shlamovitz GZ, Mower WR, Bergman J et al. (2007) Lack of evidence to support routine digital rectal examination in pediatric trauma patients. Pediatr Emerg Care 23: 537–543

    Article  PubMed  Google Scholar 

  37. Siegel JH, Dalal SA, Burgess AR et al. (1990) Pattern of organ injuries in pelvic fracture: impact force implications for survival and death in motor vehicle injuries. Accid Annal Prev 22: 457–466

    Article  CAS  Google Scholar 

  38. Taffet R (1997) Management of pelvic fractures with concomittant urologic injuries. Orthop Clin North Am 28: 389–396

    Article  PubMed  CAS  Google Scholar 

  39. Tarman GJ, Kaplan GW, Lerman SL et al. (2002) Lower genitourinary injury and pelvic fractures in pediatric patients. Urology 59: 123–126

    Article  PubMed  Google Scholar 

  40. Tile M, Helfet D, Kellam J et al. (1995) Comprehensive classification of fractures. M.E. Müller Foundation, Bern, 61: 1–6

  41. Tscherne H, Pohlemann T, Gänsslen A (2000) Klassifikation, Einstufung, Dringlichkeit und Indikation bei Beckenverletzungen. Zentralbl Chir 125: 717 ff

    Article  PubMed  CAS  Google Scholar 

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Danksagung

Wir danken der Radiologischen Abteilung der BG-Unfallklinik Murnau (CA Dr. Esch) für die Anfertigung der Abbildungen 3, 5 und 7a.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. BG-Unfallklinik, Prof.-Küntscher-Straße 8, 82418 , Murnau, Deutschland

    A. Thannheimer & V. Bühren

  2. Urologische Abteilung, BG-Unfallklinik, Murnau, Deutschland

    D.-H. Leuth

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  1. A. Thannheimer
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  2. D.-H. Leuth
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  3. V. Bühren
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Correspondence to A. Thannheimer.

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Thannheimer, A., Leuth, DH. & Bühren, V. Komplexverletzung des Beckens. Trauma Berufskrankh 10, 102–109 (2008). https://doi.org/10.1007/s10039-008-1385-x

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