Intra-pelvic pressure changes after pelvic fracture: A cadaveric study quantifying the effect of a pelvic binder and limb bandaging over a bolster

Morris, Rhys; Loftus, Andrew; Friedmann, Yael; Parker, Paul; Pallister, Ian

doi:10.1016/j.injury.2017.01.046

Cited by 28 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additional bandaging of the lower limbs led to a pressure of 31 cmH 2 O (SE = 7). In our study, the mean pelvic pressure obtained by combining a T-POD over the greater trochanter and lower limb bandaging was lower than the results described by Morris et al, which might be due to a pressure-induced leakage of fluid from the bladder into the ureters [ 22 ]. In contrast to our study, the effects of pelvic binder application at a level above and below the greater trochanters were not investigated by Morris et al…”

Section: Discussioncontrasting

confidence: 74%

“…In a study similar to ours, Morris et al measured the intrapelvic pressure in six unembalmed human cadaveric specimens with surgically created unstable pelvic injuries (C61-C1 OA/OTA) when applying a T-POD at the level of the greater trochanters and bandaging the lower limbs [ 22 ]. To record the pressure inside the pelvis a balloon was placed in the retropubic space.…”

Section: Discussionmentioning

confidence: 99%

“…One limiting factor of our study is the small sample size, which may have contributed to a lack of statistical significance in some of our findings. However, there have been several comparable studies in the past with a similar number of human cadaveric specimens [ 22 , 30 , 36 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another limiting factor could be the use of the vesical pressure as a correlate for the intrapelvic pressure. Morris et al suggest, that there may be a pressure-related leakage of fluid from the bladder into the ureters [ 22 ]. As a result, the pressure measured in the bladder may not fully reflect the intrapelvic pressure.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of T-POD and SAM Pelvic Sling II and the influence of attachment level in the initial management of unstable pelvic type C injuries – a cadaveric study

Privalov,

Junge,

Jung

et al. 2024

Int J Emerg Med

View full text Add to dashboard Cite

Background Type C pelvic fractures (AO/OTA) are severe injuries that frequently lead to bleeding and hemodynamic instability. Pelvic binders play a crucial role in their initial management. Placement at the correct level in the prehospital setting is challenging. The aim of this study was to compare two pelvic binders regarding their effectiveness in reducing intrapelvic volume and increasing intrapelvic pressure in patients with type C pelvic fractures (AO/OTA) when applied at three different levels. Methods Rotationally and vertically unstable pelvic injuries (AO/OTA classification 61-C1.1) were produced in five fresh-frozen human cadaveric specimens. Intrapelvic volume, vesical pressure and compression pressure within the pubic symphysis and the sacroiliac joint were measured when applying a SAM Pelvic Sling II and a T-POD at the level of the greater trochanter as well as levels higher and lower than recommended. Results Comparison of the two pelvic binders positioned at the recommended level (greater trochanter) showed no significant difference in volume reduction (13.85 ± 31.37 cm3, p = 0.442), however, increase in vesical pressure was significantly higher when using the T-POD (5.80 ± 3.27 cmH2O, p = 0.017). When positioned at the level of the iliac crest, vesical pressure increase and intrapelvic volume reduction were significantly greater with the T-POD (14.00 ± 8.57 cmH2O, p = 0.022 and 10.45 ± 5.45 cm3, p = 0.031 respectively). Application of the SAM Pelvic Sling II below the greater trochanter led to a significantly greater decrease in volume (-32.26 ± 7.52 cm3, p = 0.003) than the T-POD. Comparison of the recommended attachment level with incorrect positioning led to no significant differences for the T-POD, while the SAM Pelvic Sling II achieved a significantly lower volume reduction when placed at the iliac crest (40.15 ± 14.57 cm3, p = 0.012) and a significantly lower increase in vesical pressure when applied below the greater trochanter (3.40 ± 1.52 cmH2O, p = 0.007). Conclusion Direct comparison of the two pelvic binders showed that the T-POD achieved significantly greater results when applied at the recommended level and was less susceptible to incorrect positioning. These outcomes support the preferred use of the T-POD for prehospital emergency pelvic stabilisation.

show abstract

Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of T-POD and SAM Pelvic Sling II and the influence of attachment level in the initial management of unstable pelvic type C injuries – a cadaveric study

Privalov,

Junge,

Jung

et al. 2024

Int J Emerg Med

View full text Add to dashboard Cite

show abstract

“…Bleeding from pelvic fractures is mostly venous due to presacral vascular disruption into an increased pelvic volume with lack of tamponade. A pelvic binder stabilizes pelvic structures, reduces pelvic volume thereby increasing pressure within the pelvic cavity and limiting further bleeding [10]. Although there is no high-quality evidence yet available to document a survival benefit and with rather mixed results from retrospective studies the latest US military Tactical Combat Casualty Care (TCCC; [11]) update and the civilian London Faculty of Pre-Hospital Care (FPHC; [12]) consensus document promote the early/liberal use of pelvic binders in trauma patients with suspected pelvic fracture and high energy blunt force/blast injury (Table 1).…”

Section: Hemostatic Devicesmentioning

confidence: 99%

Effective approaches to address noncompressible torso hemorrhage

Maegele

2024

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of the review Noncompressible torso hemorrhage (NCTH) is now considered as the major cause of preventable death after both severe military and civilian trauma. Around 20% of all trauma patients still die from uncontrolled exsanguination along with rapidly evolving hemostatic failure. This review highlights the most recent advances in the field and provides an outline for future research directions. Recent findings The updated definition of NCTH includes a combination of high-grade anatomical torso injury, hemodynamic instability, urgent need for hemorrhage control and aggressive hemostatic resuscitation. Therapeutic concepts consider the following three aspects: control the bleeding source (close the tap), resuscitate to maintain organ perfusion and restore hemostasis (fill the tank), and increase the body's resistance against ischemia (upgrade the armor). Summary The concepts for the early management of NCTH have substantially evolved over the last decade. The development of new devices and techniques combined with early intervention of hemostatic failure have contributed to more successful resuscitations. Future research needs to refine and validate their potential clinical application.

show abstract

Single‐cell sequencing combined with spatial transcriptomics reveals that the IRF7 gene in M1 macrophages inhibits the occurrence of pancreatic cancer by regulating lipid metabolism‐related mechanisms

Zhan,

Zou,

Han

et al. 2024

Clinical & Translational Med

View full text Add to dashboard Cite

AimThe main focus of this study is to explore the molecular mechanism of IRF7 regulation on RPS18 transcription in M1‐type macrophages in pancreatic adenocarcinoma (PAAD) tissue, as well as the transfer of RPS18 by IRF7 via exosomes to PAAD cells and the regulation of ILF3 expression.MethodsBy utilising single‐cell RNA sequencing (scRNA‐seq) data and spatial transcriptomics (ST) data from the Gene Expression Omnibus database, we identified distinct cell types with significant expression differences in PAAD tissue. Among these cell types, we identified those closely associated with lipid metabolism. The differentially expressed genes within these cell types were analysed, and target genes relevant to prognosis were identified. Flow cytometry was employed to assess the expression levels of target genes in M1 and M2 macrophages. Cell lines with target gene knockout were constructed using CRISPR/Cas9 editing technology, and cell lines with target gene knockdown and overexpression were established using lentiviral vectors. Additionally, a co‐culture model of exosomes derived from M1 macrophages with PAAD cells was developed. The impact of M1 macrophage‐derived exosomes on the lipid metabolism of PAAD cells in the model was evaluated through metabolomics analysis. The effects of M1 macrophage‐derived exosomes on the viability, proliferation, division, migration and apoptosis of PAAD cells were assessed using MTT assay, flow cytometry, EdU assay, wound healing assay, Transwell assay and TUNEL staining. Furthermore, a mouse PAAD orthotopic implantation model was established, and bioluminescence imaging was utilised to assess the influence of M1 macrophage‐derived exosomes on the intratumoural formation capacity of PAAD cells, as well as measuring tumour weight and volume. The expression of proliferation‐associated proteins in tumour tissues was examined using immunohistochemistry.ResultsThrough combined analysis of scRNA‐seq and ST technologies, we discovered a close association between M1 macrophages in PAAD samples and lipid metabolism signals, as well as a negative correlation between M1 macrophages and cancer cells. The construction of a prognostic risk score model identified RPS18 and IRF7 as two prognostically relevant genes in M1 macrophages, exhibiting negative and positive correlations, respectively. Mechanistically, it was found that IRF7 in M1 macrophages can inhibit the transcription of RPS18, reducing the transfer of RPS18 to PAAD cells via exosomes, consequently affecting the expression of ILF3 in PAAD cells. IRF7/RPS18 in M1 macrophages can also suppress lipid metabolism, cell viability, proliferation, migration, invasion and intratumoural formation capacity of PAAD cells, while promoting cell apoptosis.ConclusionOverexpression of IRF7 in M1 macrophages may inhibit RPS18 transcription, reduce the transfer of RPS18 from M1 macrophage‐derived exosomes to PAAD cells, thereby suppressing ILF3 expression in PAAD cells, inhibiting the lipid metabolism pathway, and curtailing the viability, proliferation, migration, invasion of PAAD cells, as well as enhancing cell apoptosis, ultimately inhibiting tumour formation in PAAD cells in vivo. Targeting IRF7/RPS18 in M1 macrophages could represent a promising immunotherapeutic approach for PAAD in the future.

show abstract

Intra-pelvic pressure changes after pelvic fracture: A cadaveric study quantifying the effect of a pelvic binder and limb bandaging over a bolster

Cited by 28 publications

References 25 publications

Comparison of T-POD and SAM Pelvic Sling II and the influence of attachment level in the initial management of unstable pelvic type C injuries – a cadaveric study

Comparison of T-POD and SAM Pelvic Sling II and the influence of attachment level in the initial management of unstable pelvic type C injuries – a cadaveric study

Effective approaches to address noncompressible torso hemorrhage

Single‐cell sequencing combined with spatial transcriptomics reveals that the IRF7 gene in M1 macrophages inhibits the occurrence of pancreatic cancer by regulating lipid metabolism‐related mechanisms

Contact Info

Product

Resources

About