Einfluss der externen Beckenstabilisierung bei hämodynamisch instabilen Beckenfrakturen

Esmer, E.; Derst, P.; Schulz, Manfred; Siekmann, Holger; Delank, Karl‐Stefan; Dgu, das TraumaRegister

doi:10.1007/s00113-015-0119-3

Cited by 22 publications

(22 citation statements)

References 61 publications

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“…The current literature leaves no doubt that patients in need for any emergency stabilization have a higher risk to die and to suffer from all kinds of complications [12]. However, until now it has not been analyzed whether the emergency treatment itself is effective and/or an independent risk factor for complications.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Schmal

Larsen

Stuby

et al. 2019

Injury

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Background and purpose Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate. Patients and methods The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n=957 with vs n=4,542 without). Furthermore, the subgroups with secondary surgery (n=713 vs n=1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n=24 vs n=219). Calculated odds ratios were adjusted for potential confounders. Results Patients treated by CC/EF were younger (45±20 vs 62±24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p<0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation. Interpretation Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Schmal

Larsen

Stuby

et al. 2019

Injury

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“…Somit ist auch bei Patienten mit (noch) stabilen Vitalparametern und einem entsprechendem Trauma eine Beckenschlinge prophylaktisch anzulegen. Da bei Blutungen, bedingt durch instabile Beckenfrakturen, aufgrund der großen Verteilungsräume (intrapelvin, retroperitoneal) nicht mit einer Selbsttamponade zu rechnen ist, liegt der initiale Behandlungsansatz darin, durch eine Stabilisierung des Beckenrings die Blutungsräume zu verkleinern sowie pathologische Frakturbewegungen zu reduzieren, um dadurch die Blutung zu minimieren und eine Gerinnselbildung zu ermöglichen [5,18,19]. Neben der klassischen Behelfstechnik der Umschlingung des Beckens mittels Laken oder ähnlichem (Pelvic-Sheeting) und den zumeist in der Klinik vorgehaltenen Beckenzwingen befinden sich mittlerweile verschiedene Modelle kommerziell zu erwerbender Beckenschlingen auf dem Markt (z.…”

Section: Merkeunclassified

Notfallbehandlung von Beckenverletzungen

Lechner¹,

Lampl²,

Treffer³

2017

Notarzt

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Schwere Verletzungen des Beckens gehen mit einer hohen Letalitätsrate einher, bedingt durch einen hohen Blutverlust. Deshalb sollten alle Patienten mit einem relevanten Traumamechanismus, äußeren Verletzungszeichen sowie Schmerzen im Beckenbereich bereits präklinisch mit einer Beckenschlinge versorgt werden. In diesem Beitrag wird die Durchführung einer suffizienten Blutungskontrolle in der Präklinik-und Schockraumphase dargestellt.

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“…With a proportion of 2–8%, pelvic fractures represent a rare injury. They occur most frequently in the 2nd and 3rd life decades [ 1 ] and are often the result of high-energy trauma, thus appearing in up to 20% of polytrauma patients [ 1 , 2 ]. Complex pelvic ring fractures are associated with a mortality rate of 5–42% [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Complex pelvic ring fractures are associated with a mortality rate of 5–42% [ 3 , 4 , 5 ]. In many cases, the high energy trauma causes extra and intrapelvic concomitant injuries, which can be life threatening [ 1 , 6 ]. Despite achieving improved survival rates in recent years, the mortality of open pelvic fractures is reported at up to 70% [ 1 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…In many cases, the high energy trauma causes extra and intrapelvic concomitant injuries, which can be life threatening [ 1 , 6 ]. Despite achieving improved survival rates in recent years, the mortality of open pelvic fractures is reported at up to 70% [ 1 , 7 , 8 , 9 ]. The immediate risk to life is linked to the possible occurrence of refractory hemorrhagic shock, with associated major coagulation disorders [ 3 , 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiologic, Postmortem Computed Tomography-Morphologic and Biomechanical Analysis of the Effects of Non-Invasive External Pelvic Stabilizers in Genuine Unstable Pelvic Injuries

Kleber

Haussmann

Hetz

et al. 2021

JCM

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Unstable pelvic injuries are rare (3–8% of all fractures) but are associated with a mortality of up to 30%. An effective way to treat venous and cancellous sources of bleeding prehospital is to reduce intrapelvic volume with external noninvasive pelvic stabilizers. Scientifically reliable data regarding pelvic volume reduction and applicable pressure are lacking. Epidemiologic data were collected, and multiple post-mortem CT scans and biomechanical measurements were performed on real, unstable pelvic injuries. Unstable pelvic injury was shown to be the leading source of bleeding in only 19%. All external non-invasive pelvic stabilizers achieved intrapelvic volume reduction; the T-POD® succeeded best on average (333 ± 234 cm3), but with higher average peak traction (110N). The reduction results of the VBM® pneumatic pelvic sling consistently showed significantly better results at a pressure of 200 mmHg than at 100 mmHg at similar peak traction forces. All pelvic stabilizers exhibited the highest peak tensile force shortly after application. Unstable pelvic injuries must be considered as an indicator of serious concomitant injuries. Stabilization should be performed prehospital with specific pelvic stabilizers, such as the T-POD® or the VBM® pneumatic pelvic sling. We recommend adjusting the pressure recommendation of the VBM® pneumatic pelvic sling to 200 mmHg.

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Einfluss der externen Beckenstabilisierung bei hämodynamisch instabilen Beckenfrakturen

Abstract: External pelvic stabilization seems to be an important instrument for the initial treatment of hemodynamically unstable pelvic fractures and showed a positive effect on patient mortality.

Cited by 22 publications

References 61 publications

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Notfallbehandlung von Beckenverletzungen

Epidemiologic, Postmortem Computed Tomography-Morphologic and Biomechanical Analysis of the Effects of Non-Invasive External Pelvic Stabilizers in Genuine Unstable Pelvic Injuries

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