Orthopedic Approach to the Early Management of Pelvic Injuries

Abstract

High-energy pelvic fractures in trauma patients cause significant morbidity and mortality. A systematic approach to the early evaluation and management of these patients leads to improved outcomes. The initial care of patients with a displaced pelvic fracture and hemodynamic instability should focus upon three areas: 1) resuscitation, 2) bony stability, and 3) hemorrhage control. Aggressive resuscitation with blood products and clotting factors is paramount. The initial reduction of the pelvic ring and temporary stabilization can be achieved through the use of pelvic sheeting or binder placed in the field or trauma bay. Urgent surgical stabilization with external or internal fixation is often required. Hemorrhage control can be achieved through pelvic packing and/or angioembolization. The initial management of displaced pelvic fractures is multidisciplinary and should involve close collaboration between trauma surgery, orthopedic surgery, anesthesia, and interventional radiology.

Circumferential Pelvic Antishock Sheeting

“…It serves to decrease pelvic volume, allow for clot formation, and provide temporary bony stability. 3,7 Advantages of CPAS include the accessibility and low cost of sheets, continued access to the abdomen and extremities for ongoing evaluation, access to the groin through the creation of working portals, and the option to maintain reduction with the sheet during definitive fixation of the pelvic ring. 2,3,8 Working portals are created by cutting a hole in the sheet in the area overlying the intended incision or access site.…”

“…It serves to decrease pelvic volume, allow for clot formation, and provide temporary bony stability. 3,7…”

“…The sheet should be centered over the greater trochanters to achieve appropriate reduction of the pelvic ring. 3,7 It is important that the sheet remains smooth because wrinkles may lead to skin breakdown. 3 The sheet ends are then wrapped anteriorly and crossed in an overlapping manner.…”

Explainable Transfer Learning-Based Deep Learning Model for Pelvis Fracture Detection

“…According to a study of patients with pelvis fractures in the United States [10], pelvis and abdominal bleeding are mortality's main causes in the frst six hours. In addition, the mortality rate in injured patients with pelvis fractures is 5-20% in all emergency cases [11]. Given these factors, diagnosing pelvis injuries should be done urgently without any delay.…”