Anatomical consequences of “open-book” pelvic ring disruption. A cadaver experimental study

Pelvic ring injuries carry a high mortality rate, the main cause of which, in the first 24hours, is exsanguination. Injured patients are managed by a multidisciplinary damage-control strategy. Unstable patients should have instrumentalized hemostasis without delay. Arterial embolization is an effective way of achieving this and justifies this approach being permanently available in level 1 trauma-centers. After CT assessment of injuries, stable patients can undergo arterial embolization if active arterial bleeding or vascular damage is present. The embolization methods (selective or unselective) and agents used depend on the patient's hemodynamic stage and assessment of the injury whenever possible.

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“…As veins are more fragile than arteries, venous bleeding is always present in addition to an arterial bleed [16,17].…”

Section: Exsanguination Following Pelvic Injuriesmentioning

confidence: 99%

Pelvic trauma and vascular emergencies

Scemama

Dabadie

Varoquaux

et al. 2015

Diagnostic and Interventional Imaging

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“…The retroperitoneal space is a virtual cavity whose ability to accommodate a certain volume of blood depends on the tension generated by the abdominal muscles (intra-abdominal pressure); the hematoma is contained by the abdominal wall and the limited pelvic volume [23]. When the pelvis is fractured, more blood is allowed to collect in the retro-peritoneal space due to the pubic symphysis diastasis: Baquè has showed a diastasis pubic symphysis of 5 cm result in increased pelvic volume of 20.8% [24]; in a similar study, Moos has showed that for every centimeter of diastasis occurs an increase of 4.8% from the same volume [25]. The increase in the volume pelvic determines an increase in bleeding due to the sharp fall of intrapelvic pressure.…”

Section: Discussionmentioning

confidence: 99%

External fixation in pelvic fractures

et al. 2010

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Pelvic fractures account for 4-5% of all fracturated patients, and they occur in 4-5% of polytraumatized patients. In the most of the cases, they are consequent to high-energy trauma with a high percentage of lesions of other organs (cerebral, thoracic, and abdominal lesions. The most of the patients (80%) who die are dying within the first hours after trauma for a massive hemorrhagic shock. When the pelvic fracture and the patient's hemodynamic conditions are both unstable, osteosynthesis of the fracture is mandatory. Fracture stabilization should be performed within the first hour after trauma (as soon as possible), and it should be considered as part of the resuscitation procedure. We usually make an urgent stabilization of pelvic fracture with an anterior external fixator technique. We have revised all unstable pelvic fractures treated in our department (Orthopaedic Clinic Pisa University) from 2000 up to the 2005 to determine a correct treatment protocol for these lesions. Pelvic stabilization, reducing the pelvic volume and bleeding from the stumps of fracture, determines the arrest of the hemorrhage, as evidenced by the sharp decline in the number of transfusions in postoperative period. In these cases, there is an absolute indication for an urgent pelvic stabilization. Pelvic stabilization, whether temporary or permanent, allows to control the bleeding because it (1) leads to a reduction in the volume pelvis with a containment on the retro-peritoneal hematoma (2) reduces bleeding from the fracture fragments (3) reduces motility fracture promoting the blood clotting. The stabilization of the pelvis also makes it easier to manage the patient and his mobilization for the implementation of subsequent investigations. In our experience, external fixator accounts for its characteristics the gold standard approach for the urgent stabilization of these lesions, and, for most of them, it can be used as the definitive treatment. External fixation is a quick and easy procedure for pelvic fractures stabilization for surgeons with experience with this technique.

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“…The disadvantages of a management protocol reliant solely on angioembolization include delays due to the relative unavailability of the angiography suite/interventional radiologist and that it does not address venous pelvic bleeding. The contribution of venous hemorrhage to pelvic fracture exsanguination has been recognized in previous cadaveric and clinical studies [55][56][57].…”

Section: Hemorrhage Controlmentioning

confidence: 94%

Orthopedic Approach to the Early Management of Pelvic Injuries

Weaver

Heng

2015

Curr Trauma Rep

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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.

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Anatomical consequences of “open-book” pelvic ring disruption. A cadaver experimental study

Cited by 58 publications

References 7 publications

Pelvic trauma and vascular emergencies

Pelvic trauma and vascular emergencies

External fixation in pelvic fractures

Orthopedic Approach to the Early Management of Pelvic Injuries

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