Modified Classification and Repair of Perineal Soft Tissue Injuries Associated with Open Pelvic Fractures

Fu, Guo; Wang, Dong; Qin, Bengang; Xiang, Jianping; Qi, Jian; Li, Ping; Zhu, Qian; Liu, Xiaolin; Jing, Zhu; Gu, Liqiang

doi:10.1055/s-0034-1386616

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…A study of 29 battlefield trauma patients reported mean blood requirements of 60.3 units during the first 24 h. Ring closure in these patients is often not possible, and other circumstances such as vascular, bowel, genital and bladder injuries are often coexistent[71]. In this context, haemorrhage control, concurrent regional lesions and soft tissue lesion with infection prevention are the main issues to be addressed[72-75]. Apart from clinical inspection, including consideration of possible injuries to the bowel and urinary systems, a contrast CT-scan is mandatory when the patient is haemodynamically stable.…”

Section: Resuscitationmentioning

confidence: 99%

“…Apart from clinical inspection, including consideration of possible injuries to the bowel and urinary systems, a contrast CT-scan is mandatory when the patient is haemodynamically stable. When there is a bowel lesion, early diverting colostomy is usually necessary[72-75]. Experience with battlefield pelvic wounds is often valuable in the subsequent treatment of civilian patients, particularly in relation to open blast injuries to the pelvis[71].…”

Section: Resuscitationmentioning

confidence: 99%

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Damage control orthopaedics: State of the art

Guerado¹,

Bertrand²,

Cano³

et al. 2019

WJO

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Damage control orthopaedics (DCO) originally consisted of the provisional immobilisation of long bone - mainly femur - fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised (the “second hit” effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains. Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too, normalised parameters associated with the acid-base system have been proposed, under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.

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Section: Resuscitationmentioning

confidence: 99%

Section: Resuscitationmentioning

confidence: 99%

Damage control orthopaedics: State of the art

Guerado¹,

Bertrand²,

Cano³

et al. 2019

WJO

View full text Add to dashboard Cite

show abstract

The application of the WSES classification system for open pelvic fractures—validation and supplement from a nationwide data bank

Hsu

Kuo

et al. 2022

World J Emerg Surg

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Background Open pelvic fractures are rare but complex injuries. Concomitant external and internal hemorrhage and wound infection-related sepsis result in a high mortality rate and treatment challenges. Here, we validated the World Society Emergency Society (WSES) classification system for pelvic injuries in open pelvic fractures, which are quite different from closed fractures, using the National Trauma Data Bank (NTDB). Methods Open pelvic fracture patients in the NTDB 2015 dataset were retrospectively queried. The mortality rates associated with WSES minor, moderate and severe injuries were compared. A multivariate logistic regression model (MLR) was used to evaluate independent factors of mortality. Patients with and without sepsis were compared. The performance of the WSES classification in the prediction of mortality was evaluated by determining the discrimination and calibration. Results A total of 830 open pelvic fracture patients were studied. The mortality rates of the mild, moderate and severe WSES classes were 3.5%, 11.2% and 23.8%, respectively (p < 0.001). The MLR analysis showed that the presence of sepsis was an independent factor of mortality (odds of mortality 9.740, p < 0.001). Compared with patients without sepsis, those with sepsis had significantly higher mortality rates in all WSES classes (minor: 40.0% vs. 3.1%, p < 0.001; moderate: 50.0% vs. 9.1%, p < 0.001; severe: 66.7% vs. 22.2%, p < 0.001). The receiver operating characteristic (ROC) curve showed an acceptable discrimination of the WSES classification alone for evaluating the mortality of open pelvic fracture patients [area under curve (AUC) = 0.717]. Improved discrimination with an increased AUC was observed using the WSES classification plus sepsis (AUC = 0.767). Conclusions The WSES guidelines can be applied to evaluate patients with open pelvic fracture with accurate evaluation of outcomes. The presence of sepsis is recommended as a supplement to the WSES classification for open pelvic fractures.

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Management Approach for Traumatic Complex Degloving Perineal Injuries: A Retrospective Review of 6 Cases

Lee

Salauddin

Ghazali

2022

Turkish Journal of Urology

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Modified Classification and Repair of Perineal Soft Tissue Injuries Associated with Open Pelvic Fractures

Abstract: Perineal soft tissue injuries associated with pelvic fractures can be classified into three types, and the management protocol can be planned according to the classification.

Cited by 3 publications

References 22 publications

Damage control orthopaedics: State of the art

Damage control orthopaedics: State of the art

The application of the WSES classification system for open pelvic fractures—validation and supplement from a nationwide data bank

Management Approach for Traumatic Complex Degloving Perineal Injuries: A Retrospective Review of 6 Cases

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