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Preperitoneal Pelvic Packing

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Textbook of Polytrauma Management

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Abstract

Complex pelvic ring injuries are responsible for significant morbidity and mortality in trauma patients in the setting of hemodynamic compromise and pelvic hemorrhage. An option for primary hemorrhage control for pelvic fracture-related bleeding that has become more widely accepted in the past decade is preperitoneal pelvic packing (PPP). Initial evaluation and management of patients with pelvic fractures are guided by the Advanced Trauma Life Support protocol, followed by application of a pelvic binder, chest radiograph, focused assessment with sonography in trauma (FAST) examination, and resuscitative endovascular balloon occlusion of the aorta (REBOA) placement if appropriate. If the patient remains hemodynamically unstable despite initial resuscitation and 2 units of packed red blood cells (PRBCs), the patient should be taken to the operating room emergently for external fixation and PPP. Angiography and angioembolization are reserved for patients who have persistent hemodynamic instability present after external fixation and PPP; additionally, patients who require transfusion of more than four units of PRBCs in the 12 h post-packing after normalization of coagulation indices should also undergo diagnostic angiography. Ultimately, the addition of PPP with complementary angioembolization appears to result in the lowest mortality rate for hemodynamically unstable pelvic fracture patients.

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Authors and Affiliations

  1. Department of Surgery, Denver Health Medical Center, Denver, CO, USA

    Julia R. Coleman, Ernest E. Moore & Clay Cothren Burlew

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  1. Julia R. Coleman
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  2. Ernest E. Moore
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  3. Clay Cothren Burlew
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Correspondence to Clay Cothren Burlew .

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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Coleman, J.R., Moore, E.E., Burlew, C.C. (2022). Preperitoneal Pelvic Packing. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_9

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  • DOI: https://doi.org/10.1007/978-3-030-95906-7_9

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