Management of Pelvic Ring Injuries in Unstable Patients

Rudloff, Matthew I.; Triantafillou, Kostas

doi:10.1016/j.ocl.2016.03.009

Cited by 19 publications

(14 citation statements)

References 47 publications

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“…One probable explanation can be the strength and elasticity of the arterial wall, which is able to flex in response to pressure from dislocated bony fragments. Another possible explanation can be that bleeding from large arteries in the pelvic region is often rapidly fatal (Requarth and Miller, ; Romano et al, ; Tosounidis and Giannoudis, ; Pascarella et al, ; Comai et al, ; Rudloff and Triantafillou, ; Hussami et al, ). However, we believe that the fundamental explanation of this discrepancy is behind the morphological features of the fracture (Pascarella et al, ; Hussami et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Localization of potential arterial injury during pelvic ring fractures can aid in the selective angiography performed during primary treatment of a polytraumatized patient by means of embolizing the bleeding artery (Tosounidis and Giannoudis, 2013;Lustenberger et al, 2015;Scemama et al, 2015;Rudloff and Triantafillou, 2016;Comai et al, 2016;Wiley et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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Where and what arteries are most likely injured with pelvic fractures?

et al. 2019

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Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1‐year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682–688, 2019. © 2019 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Where and what arteries are most likely injured with pelvic fractures?

et al. 2019

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“…Other center also applied the lactate level in the protocol to give picture of the end result of the unstable hemodynamic. [1][2][3][4][17][18][19] The late mortality of unstable pelvic injury caused by multiple organ failure owing to intractable hemodynamic shock. 14,[18][19][20] The main bleeding source was not the rupture artery, but the exsanguinous and the consuming of the coagulopathy components were.…”

Section: Discussionmentioning

confidence: 99%

“…Unstable pelvic fracture was diagnosed clinically by assessing antero-posterior compression, lateral compression, and vertical shear signs found. 2 Together with unstable hemodynamic (low mean arterial pressure (MAP), high heart rate (HR), low hemoglobin, and low platelet count); those conditions were managed by hemodynamic resuscitation and immediate C-clamp insertion in the emergency unit by orthopedic surgeon. The C-clamp assembly took 10 minutes then confirmed by X-ray for the accuracy of pin placement and frame assembly.…”

Section: Methodsmentioning

confidence: 99%

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

2018

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Background:The fatality rate of unstable pelvic fracture is still high (20-50%) due to acute phase hemorrhage or late multiple organ failure. The assurance for 100% survival in acute phase had been reported if the emergency room team have the right technique, right timing, and right protocol. The aim of this study was to evaluate and to date factors that influence the nonsurvival unstable pelvic fracture within 2x24 hours.Methods: This retrospective study was conducted in emergency unit of Dr. Soetomo General Hospital Surabaya during 2012-2016 for unstable pelvic fracture with unstable hemodynamic, without concomitant head or thoracic injury and admitted within 4 hours after the incident. All patients were handled according to the protocol for resuscitation and C-clamp insertion immediately. X-ray was taken after the insertion to check the C-clamp position and to confirm the diagnosis. The 2x24-hour data were taken whether the patient survive or not survive, including mean arterial pressure (MAP) pre-and post, heart rate (HR) pre-and post, and initial hemoglobin and platelet count. Data were analyzed with independent t-test and multiple regression analysis.Results: Twenty two patients were recorded as the inclusive criteria, separated into 17 survivors and 5 non-survivors. They were comprised of 14 males and 8 female patients, with an average of 31.9±15.3 years old. The MAP post, HR pre-and post, and platelet count were significantly different. The factor that influenced the survival within 2x24 hours was the MAP post C-clamp (>70 mmHg) (p<0.05). Conclusion:The acute phase 2x24-hour outcome after C-clamp insertion and resuscitation was significantly influenced by MAP post C-clamp and resuscitation.

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“…The guidelines of the Advanced Trauma Life Support (ATLS) recommend that the simple radiography of the anteroposterior pelvis be performed systematically on victims of severe blunt trauma upon admission to the trauma room 10 . The advantage of such conduct would be precisely the early identification of patients who need some form of hemostasis, such as external fracture fixation, extra-peritoneal pelvic tamponade and/or embolization by angiography [11][12][13][14][15] . Early diagnosis would decrease time to treatment and blood loss, which is essential for a better prognosis.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Pelvic X-Ray indication in blunt trauma patients using clinical criteria

Moraes

Parreira

Antunes

et al. 2020

Rev. Col. Bras. Cir.

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Objective: to identify a subgroup of blunt trauma patients with very low chance of sustaining pelvic fractures based on clinical criteria. Methods: retrospective analysis of the trauma registry data, collected in a period of 24 months. We selected adult blunt trauma patients who had a PXR on admission. The frequency of pelvic fractures was calculated for the following groups: Normal neurological examination at admission (NNE), hemodynamical stability (HS), normal pelvic examination at admission (NPE), less than 60 years old (ID<60) and absence of distracting injuries (ADI). Logistic regression analysis was carried out in order to create a probability model of negative PXR. Results: an abnormal PXR was identified in 101 (3.3%) out of the 3,055 patients who had undergone a PXR at admission. Out of these, 1,863 sustained a NNE, with 38 positive CXRs (2.0%) in this group. Considering only the 1,535 patients with NNE and HS, we found 28 positive PXRs (1.8%). Out of these, 1,506 have NPE, with 21 abnormal PXRs (1.4%). Of these, 1,202 were younger than 60 y, with 11 positive PXRs (0.9%). By adding all these criteria to the ADI, we found 2 abnormal PXRs in 502 (0.4%) cases. The probability model including all these variables had a 0,89 area under the ROC curve. Conclusions: by adding clinical criteria, it is possible to identify a group of trauma patients with very low chance of sustaining pelvic fractures. The necessity of PXR in these patients needs to be reassessed.

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Management of Pelvic Ring Injuries in Unstable Patients

Cited by 19 publications

References 47 publications

Where and what arteries are most likely injured with pelvic fractures?

Where and what arteries are most likely injured with pelvic fractures?

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

Optimizing Pelvic X-Ray indication in blunt trauma patients using clinical criteria

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