Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: A systematic review of literature

Spanjersberg, W. Richard; Knops, S.P.; Schep, N.W.L.; Lieshout, Esther M.M. Van; Patka, P.; Schipper, Inger B.

doi:10.1016/j.injury.2009.06.164

Cited by 114 publications

(78 citation statements)

References 30 publications

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“…L'association d'une instabilité hémodynamique retrouvée dans 10 % des cas fait passer la mortalité de ces traumatismes de 10 à 40 % [25]. La mise en place précoce d'un système de contention externe devrait être systématique en cas de traumatisme, comme l'est la minerve, même si aucune étude prospective bien conduite n'a apporté la preuve d'une amé-lioration éventuelle de la mortalité [26]. Les premiers dispositifs ont été proposés par le secours en montagne suisse.…”

Section: Autres Principes Thérapeutiquesunclassified

Prise en charge du traumatisé grave en secours en montagne

Savary

Champly²,

Desormais

et al. 2016

Réanimation

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La prise en charge initiale du patient traumatisé grave en montagne est axée sur la soustraction au milieu et sur le dépistage et le traitement précoce des détresses vitales. Dans cet environnement spécifique, la victime est soumise à l'isolement, aux rigueurs du climat et à l'hypoxie d'altitude. Les délais d'alerte et de prise en charge y sont régulièrement allongés. Il n'y a donc pas de place pour l'improvisation, et l'expérience du médecin de secours en montagne qui intervient sans personnel paramédical, avec du matériel spéci-fique, a une incidence pronostique certaine. Mots clés Secours en montagne · Traumatisme sévère · Choc hémorragique · Prise en charge initialeAbstract The initial management of severe trauma patients in the mountains is based on extraction from the area and early identification and treatment of life-threatening injury. In this specific environment, the victim is subjected to isolation, harsh weather conditions and altitude hypoxia. Warning times and initiation of patient care are often delayed. There is no room for improvisation and hence the experience of the emergency mountain rescue doctor who intervenes, without paramedics, with specialised equipment has a crucial impact on patient's prognosis.

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Section: Autres Principes Thérapeutiquesunclassified

Prise en charge du traumatisé grave en secours en montagne

Savary

Champly²,

Desormais

et al. 2016

Réanimation

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“…Theoretically, posterior stabilization is desirable because it facilitates tamponade and clotting around the fractured bone surfaces and disrupted veins [34]. In addition, enhanced mechanical stability would improve pain control and the care of patients in the intensive care unit.…”

Section: Introductionmentioning

confidence: 99%

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Sellei

Schandelmaier

Kobbe

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces. Questions/purposes We determined whether (1) an anterior external fixator with a second anterior articulation (X-frame) would provide posterior pelvic compression and (2) full pin insertion would deliver higher posterior compressive forces than half pin insertion. Methods We simulated AP compression Type III instability with plastic pelvis models and tested the following conditions: (1) single-pin supraacetabular external fixator (SAEF) using half pin insertion (60 mm); (2) SAEF using full pin insertion (120 mm); (3) modified fixator with X-frame using half pin insertion; (4) modified fixator using full pin insertion; and (5) C-clamp. Standardized fracture compression in the anterior and posterior compartment was performed as in previous studies by Gardner. A forcesensitive sensor was placed in the symphysis and posterior pelvic ring before fracture reduction and the fractures were reduced. The symphyseal and sacroiliac compression loads of each application were measured. Results The SAEF exerted mean compressions of 13 N and 14 N to the posterior pelvic ring using half and full pin insertions, respectively. The modified fixator had mean posterior compressions of 174 N and 222 N with half and full pin insertions, respectively. C-clamp application exerted a mean posterior load of 407 N. Conclusions Posterior compression on the pelvis was improved using an X-frame as an anterior fixation device in a synthetic pelvic fracture model. Clinical Relevance This additive device may improve the initial anterior and posterior stability in the acute management of unstable and life-threatening pelvic ring injuries.

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“…The improvised or commercial binder should be centered over the greater trochanters rather than over the iliac crests for effective stabilization. 42 The legs should be internally rotated and immobilized together to assist in reducing any suspected fracture. Once applied, pelvic binders should not be removed until after radiographic evaluation.…”

mentioning

confidence: 99%

Application of Current Hemorrhage Control Techniques for Backcountry Care: Part Two, Hemostatic Dressings and Other Adjuncts

Littlejohn

Bennett

Drew

2015

Wilderness & Environmental Medicine

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Decade-long advances in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Part one of this review covered the use of tourniquets on the extremities and the newer devices for use in junctional areas. Part two focuses on the use of hemostatic agents or dressings, pelvic binders, and tranexamic acid. Field applicable hemostatic dressings are safe and effective in controlling hemorrhage not amenable to extremity tourniquet application, and newer agents with increasing efficacy continue to be developed. Most of these agents are inexpensive and lightweight, making them ideal products for use in wilderness medicine. The use of pelvic binders to stabilize suspected pelvic fractures has gained new interest as these products are developed and refined, and the prehospital use of tranexamic acid, a potent antifibrinolytic, has been found to be life saving in patients at risk of death from severe hemorrhage. Recommendations are made for equipment and techniques for controlling hemorrhage in the wilderness setting.

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Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: A systematic review of literature

Abstract: PCCDs seem to be effective in early stabilisation of unstable pelvic fractures. However, prospective data concerning mortality and complications is lacking. Some complications, like pressure sores have been described.

Cited by 114 publications

References 30 publications

Prise en charge du traumatisé grave en secours en montagne

Prise en charge du traumatisé grave en secours en montagne

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Application of Current Hemorrhage Control Techniques for Backcountry Care: Part Two, Hemostatic Dressings and Other Adjuncts

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