Hemorrhage in pelvic fracture: who needs angiography?

Gänsslen, Axel; Giannoudis, Peter V.; Pape, Hans-Christian

doi:10.1097/00075198-200312000-00009

Cited by 143 publications

(96 citation statements)

References 71 publications

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“…It is thought to be time consuming and some studies have claimed 10 h between admission and angiography. 12 Moreover, the availability of an in-house radiologist and the ability to resuscitate patients in the angiography suite if they deteriorate are some of the concerns cited. Some of these concerns and fears lead trauma teams to discount primary angiography as a feasible and perhaps even the most important step in the management of the bleeding pelvic fracture.…”

Section: Angiography and Embolizationmentioning

confidence: 99%

Predictive parameters for angiography and embolization in the bleeding pelvic fracture

Anandakumar

Hussein

Varuun

et al. 2013

Journal of Clinical Orthopaedics and Trauma

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a b s t r a c tAim: In the bleeding pelvic fracture, decision needs to be made on definitive control of bleeding whilst resuscitation. The decision for angiography in unstable patients is difficult and this study hopes to identify the parameters that may aid in this decision. patients who underwent angiographic evaluation were identified. 11 out of the 15 had angiography and embolization done, while the remaining 4 only had angiography done.Another group of 29 patients who had not undergone angiography were identified from the main population via age-matched criteria. Clinical parameters were compared between the 15 angiography patients and the 29 non-angiography group of patients.Results: Angiography group had a larger proportion (80%) with contrast blush noted on contrast-enhanced CT scan (CECT), a higher proportion with unstable pelvic fracture patterns as classified by Tile (80%), and Young and Burgess (92.4%) ( p < 0.05). Embolized group had higher proportion (81.8%) with hematoma and with blush on CECT (100%), and higher proportion with unstable fracture patterns (UFPs) (72.7%) as classified by Tile ( p < 0.05).Positive predictive value for embolization using hematoma alone is 39% while that of blush alone is 73% and unstable Tile fracture alone is 47%. Positive predictive value of combined hematoma, blush and unstable Tile fracture pattern is 75%.Conclusion: Significant predictive factors for angiogram would be unstable pelvic fracture patterns, presence of hematoma and contrast blushing on CT.

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Section: Angiography and Embolizationmentioning

confidence: 99%

Predictive parameters for angiography and embolization in the bleeding pelvic fracture

Anandakumar

Hussein

Varuun

et al. 2013

Journal of Clinical Orthopaedics and Trauma

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“…16 In some studies that favor primary definitive stabilization, the data suggest that early total care (ETC) had only been performed in patient groups with lower injury severity scores. [97][98][99] To classify patients in a critical condition, general surgeons use the term ''triad of death,'' 81 consisting of the degree of shock, hypothermia, and coagulopathy. 109 Although these factors have been largely tested in patients with penetrating injuries, 110 we confirmed that they are also relevant for patients with blunt trauma and appear to be feasible for use in the decision-making process in the emergency room.…”

Section: Resultsmentioning

confidence: 99%

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Pape

2008

Journal Orthopaedic Research

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In the treatment of polytrauma patients, multiple studies have shown how the timing and the type of the initial surgery of long bone fractures influence the incidence of systemic complications. Database analyses documented that unduly long surgical procedures undertaken early after trauma increase the risk of acute respiratory distress syndrom (ARDS), especially when femoral shaft fractures are stabilized. Animal research and prospective clinical studies also support the fact that the type of stabilization of a femoral shaft fracture may influence the systemic response to trauma. Reamed intramedullary reaming and nailing for a femoral shaft fracture is associated with an increased risk of pulmonary fat embolization from the medullary canal. This can result in pulmonary compromise if certain cofactors are also present. Modified reamers have been developed to reduce this side effect. The mediating effects are immunologic changes, varying according to the magnitude of the surgical procedure. Pro-inflammatory markers (e.g., Interleukins) may be used to assess the inflammatory response to injury as well as the magnitude of surgery and the systemic impact induced by surgery. Serum levels of such markers can be used clinically to tailor the amount of surgery that is performed to the clinical condition of the patient. The potentially negative impact of excessive surgery in high-risk patients can be avoided by using a new grading system for the assessment of the clinical status of the injured patient. Most recently, a large prospective randomized multicenter study has documented that this grading system is effective for identifying these borderline patients, and that in the borderline patient a staged surgical approach, such as temporary femoral stabilization with an external fixator, reduces the incidence of systemic complications. This work has changed the surgical management of multiply injured patients toward an approach that is tailored to the clinical condition of the patient, as indicated by well-defined clinical parameters as well as objective measurements of serum cytokine levels. ß

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“…While the external fixation of the iliac wings is excellent at controlling the anterior pelvic ring and managing fracture patterns that involve primarily anterior displacement or "open book"-type injuries, injuries that involve the significant displacement of the posterior pelvic ring are often poorly controlled with external fixation alone [43,44]. External fixator pins are placed into the anterior ring, and given the long lever arm between the posterior ring and the anterior frame, there is little ability to directly control the posterior pelvic ring.…”

Section: Bony Stabilitymentioning

confidence: 99%

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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Hemorrhage in pelvic fracture: who needs angiography?

Cited by 143 publications

References 71 publications

Predictive parameters for angiography and embolization in the bleeding pelvic fracture

Predictive parameters for angiography and embolization in the bleeding pelvic fracture

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Orthopedic Approach to the Early Management of Pelvic Injuries

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