Team Approach: Evaluation and Management of Pelvic Ring Injuries

Abstract

» A multidisciplinary approach to the management of pelvic ring injuries has been shown to decrease mortality rates.» The primary goals within the emergency room are to assess, resuscitate, and stabilize the patient. The Advanced Trauma Life Support protocol guides the initial assessment of the patient. A pelvic binder or sheet should be applied to help to provide reduction of the fracture and temporary stabilization.» The trauma team becomes the primary service for the patient as he or she transitions away from the emergency department. The trauma team must effectively communicate with and serve as the liaison between other specialists as injuries are identified.» emodynamic stability should be closely monitored in patients with pelvic ring injuries, involving the assessment of vital signs, imaging findings, and clinical judgment.» Angioembolization and peritoneal packing may play a role in helping to control hemorrhage.» Urologists should be consulted if a Foley catheter cannot be passed or there is concern for urethral or bladder injury. Further imaging or urologic intervention may be necessary.» Orthopaedic surgeons can help to assess the patient, classify the injury, and assist in temporary stabilization while planning definitive fixation.

Team Approach: The Unstable Trauma Patient

“…During the ATLS primary survey and circulatory assessment stage, the pelvis is examined and checked for instability. If the pelvis is deemed unstable, through a combination of physical examination and imaging, a pelvic binder is applied, if not already applied in the field by paramedics, and can lead to substantial volumetric reductions and potential tamponade of life-threatening bleeding 31 . Early communication and consultation with orthopaedic surgery can help facilitate further management of pelvic ring injuries that may need stabilization.…”

“…This paradigm is particularly supported in the setting of pelvic injury 51,56 . While no specific algorithm exists, traditional indications for angiography in the unstable patient includes the hemodynamically unstable patient with a clearly unstable fracture pattern, at high risk of arterial injury, the transient responder after binder placement and initial resuscitation, and clear CT evidence of arterial extravasation 31,54,57 .…”

TiRobot‑assisted versus conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation for pelvic ring injuries: a meta‑analysis

“…Traditional fixation methods include open reduction internal fixation with plates from the anterior and posterior pathways, external fixation, and minimally invasive percutaneous screw fixation [ 5 , 6 ]. With the advancement of medical technology and the popularization of minimally invasive concepts, the clinical application of open reduction and plate fixation is less frequent at present [ 6 ].…”

“…Traditional fixation methods include open reduction internal fixation with plates from the anterior and posterior pathways, external fixation, and minimally invasive percutaneous screw fixation [ 5 , 6 ]. With the advancement of medical technology and the popularization of minimally invasive concepts, the clinical application of open reduction and plate fixation is less frequent at present [ 6 ]. The percutaneous IS screw fixation is becoming increasingly popular worldwide with the advantages of less surgical trauma, less bleeding, fewer infection rates, fewer complications, earlier mobilization, and benefits for second-stage anatomical reconstruction surgery [ 6 ].…”

“…With the advancement of medical technology and the popularization of minimally invasive concepts, the clinical application of open reduction and plate fixation is less frequent at present [ 6 ]. The percutaneous IS screw fixation is becoming increasingly popular worldwide with the advantages of less surgical trauma, less bleeding, fewer infection rates, fewer complications, earlier mobilization, and benefits for second-stage anatomical reconstruction surgery [ 6 ]. However, due to the unique anatomical structure of the posterior pelvic ring and the numerous influencing factors during C-arm fluoroscopies, such as morbidly obese patients or bowel gas, it is challenging to ensure the best position of each screw through manual operation under X‐ray monitoring [ 7 ].…”