Availability and use of resources for emergency fracture care of pelvic trauma associated with haemorrhagic shock in Latin America: A cross-sectional study

Altamirano-Cruz, Marco Antonio; Velarde, Jorge Enrique; Valderrama-Molina, Carlos Oliver; Azi, Matheus; Belangero, William Dias; Bidolegui, Fernando; Carabelli, Guido Sebastián; Gómez, Amparo; Pires, Robinson Esteves; Xicará, José Arturo; Giordano, Vincenzo

doi:10.1016/j.injury.2023.04.020

Cited by 1 publication

(1 citation statement)

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“…In conclusion, in the survey carried out by the SICOT trauma committee, CT scan was used by 93%, most trauma surgeons use a routine pre-hospital pelvic binder, external fixation was the standard method of acute fixation, and ilio-sacral screws were the most used technique for definitive fixation, but not as immediate treatment (17). Having a well-trained surgeon on call in any hospital that promptly performs accurate fixation is very rare, although in the case of pelvic fractures and hemorrhagic shock, it may be critical (33).…”

Section: Immediate Stabilization With Transiliactranssacral Screwsmentioning

confidence: 99%

Immediate management of a stable patient with unstable pelvis

Cano,

Bogallo,

Ramirez

et al. 2024

EFORT Open Reviews

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The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion. For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding. The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient’s general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

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Section: Immediate Stabilization With Transiliactranssacral Screwsmentioning

confidence: 99%