Kontrolle diffuser Blutungen bei instabiler Beckenfraktur mittels Kompressionsplattentamponade

Abstract

Current recommendations on surgical management of unstable pelvic fracture with hemorrhagic shock include reduction and fixation, i.e., with a C-clamp and external fixator, angiographic embolization of injured pelvic arteries, and preferably extraperitoneal packing to control diffuse bleeding from the venous plexus and fracture site. However, the recently reported lethality at 40-60% remains seriously high. One possible reason could be the unsatisfactory efficiency of extraperitoneal packing in the case of a traumatically or surgically opened retroperitoneal compartment. In this paper, a new approach, so-called compression plate packing, is proposed to control diffuse bleeding. In this technique, the essential pressure of the packing on the bleeding site is set up with small fragment plates with screw fixation to the pelvic ring. In two first clinical cases of severe pelvic trauma the hemorrhage could be controlled reliably.

Komplexes Beckentrauma

“…Die pelvinen Begleitverletzungen sind häufig äußerst komplex und stellen den behandelnden Unfallchirurgen vor große Herausforderungen. Nur im interdisziplinären Setting unter Nutzung aller Ressourcen ist ein optimales Behandlungsergebnis realisierbar [ 1 , 2 , 6 , 9 , 10 , 14 , 15 , 18 ].…”

“…Verletzungen der großen Gefäße machen eine chirurgische Intervention notwendig. Bei arteriellen Blutungen kommt der interventionellen Angiographie eine hohe Bedeutung zu [ 1 , 5 , 8 , 10 , 19 ].…”