The importance of pelvic ring stabilization as a life-saving measure in pre-hospital – A case report commented by autopsy

Abstract

Keywords:Unstable pelvic ring Open book pelvic fracture Hemorrhagic shock A B S T R A C T Hip fractures with unstable pelvic ring have great morbidity and mortality rates. These fractures result from high energy trauma such as falls from heights, road accidents and collapsing structures or other similar mechanisms of action. We report the case of a 63 years old man, construction worker, who stood inside a ditch during a wall construction when he was surprised by this collapse, which resulted in direct trauma to the right thigh and pelvis. The autopsy revealed diaphysis fracture of the right femur with an open book pelvic fracture with severe hemorrhagic infiltration and hematoma of the pelvic muscles without arterial injury. Bone bleeding and the vascular damage associated with disruption of the sacroiliac ligaments promote a very significant bleeding. Simple maneuvers such as sheet circumferential compression to promote pelvic ring closure are effective on stabilizing and closure of the sacroiliac joint. Hip manipulation of the fracture was performed during the necropsy to demonstrate and prove how a simple sheet contention can promote stabilization of the pelvic ring by closing the sacroiliac joints in open book fractures.

Stabilizacija pubične simfize kod rotatorno i vertikalno nestabilnih preloma karlice - prikaz slučaja

“…Oko 3% svih preloma kostiju pripada disrupciji karličnog prstena [1]. Nastaju dejstvom mehaničke sile velike energije u saobraćaju, padom sa visine ili udarom mehaničkog oruđa.…”

O impacto da fratura de pelve em livro aberto na morbimortalidade de pacientes politraumatizados, principais fatores de risco e formas de tratamento.

“…Essas fraturas resultam de traumas de alta energia, como quedas de altura, acidentes rodoviários e estruturas em colapso ou outros mecanismos semelhantes de alta ação cinética. As fraturas pélvicas resultantes desses cenários são frequentemente associadas a lesões abdominais, pélvicas ou torácicas 1 .…”

The Emergency Department Application of a Windlass to a Bedsheet Pelvic Circumferential Compression Device

“…A recently published article in your journal emphasized the importance of pelvic ring stabilization in the management of an open-book fracture. 1 It has been emphasized that, because of the significant morbidity and mortality associated with this type of trauma, the early application of a pelvic circumferential compression device (PCC) can achieve fracture stabilization and reduce hemodynamic deterioration. 2,3 The conclusion by Durão, et al was that a modest maneuver with equipment such as a bedsheet can be effective in fracture stabilization.…”

“…2,3 The conclusion by Durão, et al was that a modest maneuver with equipment such as a bedsheet can be effective in fracture stabilization. 1 If one considers the bedsheet as the "strap" of a hemorrhagecontrol tourniquet, then it must also be hypothesized that the introduction of a large windlass, seen with commercial tourniquets, would improve improvised PCC efficacy. One study involving a simulated extremity hemorrhage revealed that the introduction of a windlass to a circumferential strap significantly stopped "bleeding" compared to a strap alone and the use of this adjunct has received acceptance in wilderness and military medical practice under specific circumstances.…”