Comparison between External Fixation and Pelvic Binder in Patients with Pelvic Fracture and Haemodynamic Instability who Underwent Various Haemostatic Procedures

Abstract

Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic fracture patients with haemodynamic instability. Pelvic external fixation (PEF) and pelvic binder (PB) are usually applied with haemostatic procedures to reduce the pelvic volume. This study aimed to compare the clinical outcomes between patients who underwent PEF and PB. Among 173 patients with pelvic fracture admitted to the emergency room of three regional trauma centres between January 2015 and December 2018, the electronic charts of haemodynamically unstable patients were retrospectively analysed. Among 92 patients included in the analysis, 21 patients underwent PEF and 71 patients underwent PB. There were significant differences in tile classification and laparotomy between the PEF and PB groups (p = 0.018 and p = 0.046). PPP tended to be more frequently preformed in the PEF group (p = 0.074), whereas PA tended to be more commonly performed in the PB group than in the PEF group (p = 0.058). After propensity score matching to adjust for differences in patient characteristics and adjunct haemostatic procedure, there was a significant difference in haemorrhage-induced mortality between the PEF and PB groups (0% vs 25%, p = 0.047). Kaplan–Meier curve analysis also showed a significant difference in haemorrhage-induced mortality between the two groups (log-rank test, p = 0.020). Among the volume reduction procedures performed with other haemostatic procedures in patients with pelvic fracture and haemodynamic instability, PEF significantly reduced haemorrhage-induced mortality compared to PB.