Management of Acute Hemorrhage in Pelvic Trauma: An Overview

Abstract

Pelvic disruption is a combination of fractures or dislocations of the pelvic ring with trauma of the soft tissues on the inside and outside of this ring. Hemodynamic instability is the result of blood loss out of the fracture fragments, the posterior venous plexus, ruptured pelvic organs, or arterial lesions. In the resuscitation phase, different measures are possible to reduce the volume of the disrupted pelvis and to restore mechanical stability. They are not competitive but complementary. Pelvic binders should be used in the prehospital phase before and during transport. Application of a pelvic C-clamp is restricted to inhospital patients with C-type pelvic ring lesions and with severe and ongoing hemodynamic instability. External fixation is most useful in B-type but also has limited value in C-type injuries. The prerequisite for pelvic packing is the restoration of mechanical stability by pelvic C-clamping or external fixation. It is effective in severe venous bleeding in the small pelvis. Pelvic angiography and selective embolization is performed in patients with active arterial bleeding. These patients can be identified by a convincing clinical picture, by early multislice computed tomography (CT) with contrast- enhanced angiographic technique, or by the persistent need for volume replacement after C-clamping, external fixation, or pelvic packing.

Pelvic trauma: WSES classification and guidelines

“…The rationale for acute external pelvic fixation consists of (1) reducing the intrapelvic volume in “open book” equivalent injuries to decrease the retroperitoneal bleeding space, and (2) to provide a stable counter-pressure to the “packed” lap sponges for effective pelvic packing. For example, pelvic packing is not effective in absence of adequate counterpressure by posterior pelvic elements, which requires external fixation for unstable pelvic ring disruptions [56, 87, 98]. The technical aspects of decision-making for the modality of “damage control” external fixation for unstable pelvic ring injuries have been described elsewhere [58].…”

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

“…They typically occur in high-speed traffic accidents, crush traumas or falls from great height. Due to massive blood loss, they can be life-threatening (8). In many patients, there are additional lesions of intrapelvic structures such as the bladder, urethra, and nerves.…”

Factors that influence the survival of unstable pelvic fracture in the acute phase

“…Either one technique or protocol is effective if executed with the right technique, right timing, in the right patient. 5 Since pelvic fracture is only 3%, limited patients and limited cases make it hard for the orthopedic trainee to be experienced with the device. The training for orthopedic surgeon is an obligation.…”

“…Monitoring and evaluation of the outcome would give feed back to the institution. [4][5][6][7] There was still no evaluation for the efficacy of this procedure in treating unstable pelvis. The aim of this study was to evaluate and to date factors that influenced the non-survival unstable pelvic fracture within 2x24-hours.…”