Guidelines for the management of haemodynamically unstable pelvic fracture patients

Abstract

The consensus committee successfully developed best evidence recommendations identifying the issues and providing guidelines and options for this challenging condition.

A case series of pelvic fracture patients who developed lower urinary tract symptoms after transarterial embolization of bilateral internal iliac arteries

“…Transarterial embolization (TAE) is an effective method for control of arterial bleeding associated with pelvic fractures,1, 2 and its use is recommended in several guidelines as the primary method of hemostasis for hemodynamically unstable patients 3, 4. The standard embolization technique in this context is total embolization of the bilateral internal iliac arteries, even if the bleeding source is unilateral 5.…”

Acute management of high-energy pelvic ring injuries

“…There are several studies showing benefits of emergency non-invasive pelvic ring stabilization [12,13,14], but very little data is available so far on the efficacy and safety of the method [15]. Since emergency non-invasive pelvis stabilization was recommended by ATLS [16] and ITIM NSW [17,18], and is widely used, concerns about safety arouse.…”

“…The high-pressure arterial bleeding is usually not self limiting like some of the low-pressure venous bleeders. Using angiography for diagnosis and treatment of PFRAB is widely used [17,18,23,24,25,26]. There is general agreement that it is the best option to control PFRAB however timing of the procedure is less uniform.…”

“…Emergency non-invasive pelvic ring immobilization is recommended by ATLS [16] and also by state level (ITIM) evidence-based guidelines [17,18]. The technique of Pelvic Binding (PB) is described and recommended to use immediately when pelvic ring injury is recognized or highly suspected.…”

“…There is no general agreement in the way these haemostatic efforts are carried out and no agreement in the best sequence. Local resources and team training play important role in the development of institutional guidelines to manage these challenging situations [17,18,23,24,25,26]. Beside haemostatic resuscitation with blood products and fluids, all guidelines include some sort of emergency pelvic ring stabilization: either non-invasively with application of sheet wrapping or custom made orthesis or invasively with an external fixator [33] or the pelvic C-clamp [34].…”