Pelvic Fractures With Associated Retroperitoneal Hematoma: Time Until Angioembolization and Results

Hernández, Patricia Ciriano; Hidalgo, Ana Moreno; Torrente, Irene Grao; Moreno, Cristina Ruiz; Rodrigez, Leticia Seisdedos; Mata, Silvia Kayser; Boyra, Miguel Jesús Echenagusia; Leyte, Manuel González; Díaz, María Dolores Pérez; Fuentes, Fernando

doi:10.1016/j.cireng.2019.04.011

Cited by 2 publications

(3 citation statements)

References 21 publications

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“…In addition, previous studies have mentioned that the outcomes of PF are dependent on the severity of associated injuries and hemodynamics on admission due to the context of multiple traumas rather than the unstable pattern of PF [4]. Even though a simple pelvic ramus fracture might lead to a severe pelvic hemorrhage or an enhancement, CT of the PF without the presence of contrast extravasation cannot entirely exclude arterial bleeding, both of which have been described previously in the literature [2,9,27,28]. As mentioned above, rapid decision making for unstable patients with blunt abdominopelvic trauma despite mild hemoperitoneum and simple PF is challenging for trauma surgeons.…”

Section: Discussionmentioning

confidence: 96%

“…In addition to intraperitoneal bleeding from blunt abdominal trauma (BAT), retroperitoneal bleeding should be considered in unstable patients with concomitant pelvic fracture (PF). Similarly, patients with any PF may experience a concomitant intra-abdominal injury from 16% to 42%, which has increased from 62% to 77% in patients with concomitant retroperitoneal hemorrhage and 70% in unstable patients, respectively [1][2][3][4][5]. PF also results in approximately 7% to 13% retroperitoneal hemorrhages requiring emergency interventions and 7.6% to 55% HI [3,4,[6][7][8][9], contributing to a mortality rate of 4.3% to 19%, and even up to 31% to 46% in unstable patients [4][5][6]8,10,11].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted?

Hsieh,

Chuang,

Liu

et al. 2023

Life

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The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt bowel mesenteric injury (BBMI). This study aimed to determine the risk factors associated with hemodynamically unstable patients with BBMI and to test the hypothesis that pelvic fracture is an independent risk factor for patients with unstable BBMI and concomitant pelvic fracture to guide the therapeutic sequence for difficult-to-manage patients. This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2021 and included 158 adult patients with surgically proven BBMI. The patients were divided on the basis of the presence of a shock episode before emergency laparotomy. The shock group included 44.3% of all patients in the study (n = 70). Clinical injury severity and prognosis for patients in the shock group were poorer than those for patients in the non-shock group, and more invasive treatments and transfusions were performed for patients in the shock group than for those in the non-shock group. Pelvic fractures were more frequently associated with the shock group than with the non-shock group (21.4% vs. 5.7%; p = 0.003). In multivariate analysis, the presence of intracerebral hemorrhage (odds ratio [OR] = 10.87, 95% confidence intervals [CIs]: 1.70–69.75) and rib fracture (OR = 5.94, 95% CIs = 1.06–33.45) was identified as an independent predictor of shock, whereas the effect of pelvic fracture did not achieve statistical significance (OR = 2.94, 95% CIs = 0.66–13.13) after adjusting for confounding factors. For patients with BBMI, outcomes need to be improved during early diagnosis, and treatments should be expeditiously performed on the basis of the rapid identification of unstable hemodynamic status. Our results support the recommendation of emergency laparotomy in unstable patients with concomitant pelvic fractures, followed by damage control TAE if needed.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted?

Hsieh,

Chuang,

Liu

et al. 2023

Life

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“…Pelvic packing can be quickly performed within 30 min and aims to tamponade venous bleeding, which may also be performed in combination with external fixation [ 17 , 45 ]. Angioembolization, in general, requires more time and institutional resources [ 46 ]. Due to the immense personnel and equipment requirements, not all trauma centres have permanent angioembolization capabilities.…”

Section: Study Limitationsmentioning

confidence: 99%

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

Klingebiel

Hasegawa

Parry

et al. 2023

International Orthopaedics (SICOT)

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Purpose Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. Methods A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents). Results The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization). Conclusion The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences’ impact on outcomes needs to be further explored.

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Pelvic Fractures With Associated Retroperitoneal Hematoma: Time Until Angioembolization and Results

Cited by 2 publications

References 21 publications

Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted?

Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted?

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

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