Therapeutical Strategies and Outcome of Polytraumatized Patients with Pelvic Injuries A Six-Year Experience

Ertel, Wolfgang; Eid, Karim; Keel, Marius; Trentz, O.

doi:10.1007/pl00002452

Cited by 57 publications

(50 citation statements)

References 37 publications

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“…However, the number of patients involved in our study is too small to allow meaningful subgroup comparisons. Nonetheless our patient sample is comparable to those in other studies regarding age, gender, trauma mechanism, comorbidity, and injury severity [9,17,27]. Similarly, we had too few patients with excessive durations of ventilatory support and compromised immune defense to analyze.…”

Section: Discussionmentioning

confidence: 52%

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A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Open reduction and stabilization of dorsal pelvic ring injuries is accompanied by a high rate of soft tissue complications. Minimally invasive techniques have the potential to decrease soft tissue trauma, but the risk of iatrogenic nerve and vessel damage through the reduced surgical exposure should be considered. We treated these injuries using a transiliac internal fixator (TIFI) in a minimally invasive technique characterized by implantation of a pedicle screw and rod system, bridging the sacroiliac joints and the sacral area. Questions/purposes We asked whether (1) we could achieve anatomic restoration with the device, (2) specific complications were associated with this minimally invasive approach (particularly enhanced intraoperative blood loss, soft tissue complications, and iatrogenic neurovascular damage), and (3) function 3 years after trauma was comparable to that of established methods. Methods We retrospectively reviewed 67 patients with dorsal pelvic injuries during a 7-year period. We evaluated the (1) reduction by grading the maximal displacement measured with three radiographic views, (2) the complications during the observation period, and (3) the function with a validated questionnaire (Pelvic Outcome Score) in all but five patients at least 3 years after trauma (mean, 37 months; range, 36-42 months). Results At last followup we observed a secondary fracture displacement greater than 5 mm in one patient. The intraoperative blood loss was less than 50 mL in all patients. No neurovascular lesions occurred owing to implantation. Four patients had wound infections, one had loosening of a single pedicle screw, and one had an iatrogenic screw malpositioning. Thirty-five of the 62 patients achieved Pelvic Outcome Scores of either a maximum score or 6 of 7 points. Conclusion Our observations suggest TIFI is a reasonable alternative to other established fixation devices for injuries of the dorsal pelvic ring with minor risks of major blood loss or iatrogenic neurovascular damage.

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Section: Discussionmentioning

confidence: 52%

“…Pelvic injuries caused by high-energy lesions have a mortality rate as much as 30%, depending on the associated injuries [9]. Multiple treatment modalities are available with specific advantages and disadvantages, including the experience of the treating surgeon [26].…”

Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…[19]. Moreover, all patients were primarily treated according to the Advanced Trauma Life Support guidelines (ATLS) [20] and our standard trauma protocol [21,22]. Hip dislocation was managed in all patients by emergent closed reduction in general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

The Role of Surgical Hip Dislocation in the Treatment of Acetabular and Femoral Head Fractures

et al. 2005

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“…By exerting transverse compression across the sacroiliac joint, the basis for effective pelvic tamponade is achieved (37)(38)(39)(40). Ertel et al (12,13) from the Zurich group reported their experiences in managing multiple injured patients with severe pelvic fracture by application of a C-clamp and pelvic packing. They concluded that the combination of a pelvic C-clamp and packing can effectively control pelvic hemorrhage in patients in extremis (12,13).…”

Section: Pelvic C-clampmentioning

confidence: 99%

Management of Bleeding Pelvic Fractures

Marzi

Lustenberger

2014

Scand J Surg

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Introduction: in patients with severe pelvic fractures, exsanguinating hemorrhage represents the major cause of death within the first 24 h. despite advances in management, the mortality rate in these patients remains significantly high. recently, multiple treatment algorithms have been proposed for patients with severe pelvic fractures; however, the optimal modalities in particular in the hemodynamically unstable patient are still a matter of lively debate.this review article focuses on the recent body of knowledge on the different treatment options in patients with severe pelvic fractures and proposes the possible role of each modality in the management of these patients.Methods: the Medline database was searched for medical literature addressing the management of severe pelvic fractures with specific attention given to recent, clinically relevant publications.Results: angiography and embolization have emerged as excellent methods for addressing arterial bleeding. Mechanical pelvic stabilization and surgical hemostasis by pelvic packing, on the other hand, may effectively control venous bleeding and bleeding from the fractured bony surface. However, since there is no precise way to determine the major source of bleeding that is responsible for the hemodynamic instability, controversy remains over the timing and optimal order of angiography, mechanical pelvic stabilization, and packing.Conclusions: the author's own approach to these patients includes angiographic embolization as a first-line treatment only in hemodynamically stable patients with an arterial blush seen in the computed tomography scan, indicating acute arterial bleeding. Hemodynamically unstable patients are immediately transferred to the operating room, where pelvic packing and mechanical stabilization of the pelvic ring are carried out. optionally, a subsequent postoperative angio-embolization is performed if signs of further bleeding remain present.

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Therapeutical Strategies and Outcome of Polytraumatized Patients with Pelvic Injuries A Six-Year Experience

Cited by 57 publications

References 37 publications

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

The Role of Surgical Hip Dislocation in the Treatment of Acetabular and Femoral Head Fractures

Management of Bleeding Pelvic Fractures

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