#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Can the Sacral Spongiosa Bleeding Cause Fatal Complications of Unstable Pelvic Fracture?


Authors: V. Džupa;  L. Horák 1;  E. Gavulová 2;  J. Málek 3
Authors‘ workplace: Ortopedicko-traumatologická klinika 3. LF UK a FN Královské Vinohrady, Praha přednosta: doc. MUDr. Martin Krbec, CSc. ;  Chirurgická klinika 3. LF UK a FN Královské Vinohrady, Praha, přednosta: prof. MUDr. Robert Gürlich, CSc. 1;  Klinika anesteziologie a resuscitace 2. LF UK a FN Motol, Praha přednosta: prof. MUDr. Karel Cvachovec, CSc. 2;  Klinika anesteziologie a resuscitace 3. LF UK a FN Královské Vinohrady, Praha přednosta: prof. MUDr. Jan Pachl, CSc. 3
Published in: Rozhl. Chir., 2009, roč. 88, č. 12, s. 699-703.
Category: Monothematic special - Original

Overview

The authors present the case of 36 years old woman, who suffered from unstable fracture of pelvis after she fell from the 5th floor. The spongiosa bleeding from both massae laterales sacri caused significant blood circuit destabilisation not only immediately after the injury but also in hours following the external fixation of pelvis. Due to persistent blood losses it was necessary to apply 38 RBC units, 48 FFP units, 1500 IU of antithrombin III, 1000 mg of fibrinogen and 6 platelet units within first 12 hospitalisation hours. With respect to ongoing bleeding and lack of accessible blood products it was decided to stop intensive hemotherapy and rationalize the treatment.

The rationalization led to the hypotension (systolic blood pressure was 40–60 mm Hg), which along with gradual increase of body temperature caused unexpectable patient stabilisation. The systolic blood pressure was stabilized on 80 mm Hg and heart rate about 100/min. After 4 hours another 3 RBC units and 4 FFP units brought from the nearest reachable hospital were applied. The following blood pressure measurement was 120/80 and heart rate about 90/min. In the course of following 2 days it was possible to stop the catecholamine treatment.

The authors are of opinion, that uncovered spongiosa caused by expresive dislocation of fragments may lead to massive bleeding that is difficult to stop by accessible means. The bleeding may be an essential risk for patients life and neither targeted intensive postoperative care can settle the matter.

Key words:
pelvic injury – massive bleeding


Sources

1. Balogh, Z., Bendinelli, C., Pollitt, T., Kozar, R. A., Moore, F. A. Postinjury primary abdominal compartment syndrome. Eur. J. Trauma Emerg. Surg., 34, 2008, 4, 369–377.

2. Beekley, A. C. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit. Care Med., 36, 2008, Suppl. 3, 267–274.

3. Bottlang, M., Krieg, J. C., Mohr, M., Simpson, T. S., Madey, S. M. Emergent management of pelvic ring fractures with use of circumferential compression. J. Bone Joint Surg. Am., 84-A, 2002, Suppl. 2, 43–47.

4. Culemann, U., Tosounidis, G., Reilmann, H., Pohlemann, T. Beckenringverletzung. Diagnostik und aktuelle Behandlungsmöglichkeiten. Chirurg, 74, 2003, 7, 687–700.

5. Česká společnost anesteziologie, resuscitace a intenzivní medicíny: Doporučený postup „Život ohrožující krvácení“. Dostupné na http://www.csarim.cz/Text/metodicke-pokyny-a-stanoviska-csarim-1?MenuItemId=38, 2007.

6. Day, A. C. Emergency management of pelvic fractures. Hospital Medicine, 64, 2003, 2, 79–86.

7. Eastridge, B. J., Starr, A., Minei, J. P., O‘Keefe, G. E. The importance of fracture pattern inguiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J. Trauma, 53, 2002, 3, 446–451.

8. Geusens, E., Brys, P., Maleux, G., Janzing, H. Imaging in pelvic trauma. JBR-BTR, 83, 2000, 4, 173–180.

9. Chmelová, J., Džupa, V., Pleva, L. Diagnostika poranění pánve: role zobrazovacích metod u izolovaných traumat i polytraumat. Acta Chir. orthop. Traum. čech., 75, 2008, 2, 93–98.

10. Kreimeier, U., Lackner, C. K., Pruckner, S., Ruppert, M., Peter K. Permissive Hypotension beim schweren Trauma. Anaesthesist, 51, 2002, 10, 787–799.

11. Kushimoto, S., Masatoku, A, Aiboshi, J., Harada, N., Tosaka, A, Koido, Y., Yoshida, R., Yamamoto, Y, Kumazaki, T. The role of interventional radiology in patients requiring Damage Control Laparotomy. J. Trauma, 54, 2003, 1, 171–176.

12. Michek, J., Zelníček, P.,Wendsche, P., Tomašuk, D., Filipínský, J. Pánevní kompartment syndrom. Úraz. chir., 8, 2000, 1, 24–29.

13. Miller, P. R., Moore, P. S., Mansell, E., Meredith, J. W., Chang, M. C. External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J. Trauma, 54, 2003, 3, 437–443.

14. Mirza, A., Ellis, T. Initial management of pelvic and femoral fractures in the multiply injured patient. Crit. Care Clin., 20, 2004, 1, 159–170.

15. Mohanty, K., Musso, D., Powell, J. N., Kortbeek, J. B., Kirkpatrick, A. W. Emergent management of pelvic ring injuries: an update. Can. J. Surg., 48, 2005, 1, 49–56.

16. Olson, S. A., Rhorer, A. S. Orthopaedic trauma for the general orthopaedist. Clin. orthop., 433, 2005, 4, 30–37.

17. Otčenášek, M., Krofta, L., Báča, V., Grill, R., Kučera, E., Herman, H., Vasicka, I., Drahoňovský, J., Feyereisl, J. Bilateral avulsion of the puborectal muscle: MRI based 3-D reconstruction and comparison with a model of healthy nulliparous women. Ultrasound Obstet Gynecol., 29, 2007, 692–696.

18. Pavelka, T., Kuntscher, V., Grill, R., Chmelová, J., Džupa, V. Ošetření nestabilní zlomeniny pánve v akutní fázi: Pelvic Damage Control Surgery. Acta Chir. orthop. Traum. čech., 76, 2009, 1, 15–19.

19. Pohlemann, T., Braune, C., Gänsslen, A., Hüfner, T., Partenheimer, A. Pelvic emergency clamps: anatomic landmarks for a safe primary application. J. Orthop. Trauma, 18, 2004, 2, 102–105.

20. Pohlemann, T., Culeman, U., Tosounidis, G., Kristen, A. Die Anlage der Notfall-Beckenzwinge. Unfallchirurg, 107, 2004, 12, 1185–1191.

21. Pryor, J. P., Reilly, P. M. Initial care of the patient with blunt polytrauma. Clin. orthop., 422, 2004, 5, 30–36.

22. Rovder, P., Džupa, V., Lisý, M., Chmelová, J., Grill, R., Báča, V., Fric, M. Nestabilné zlomeniny panvy a krvácanie: úvodné opatrenia. Úraz. chir., 14, 2006, 3, 74–79.

23. Rüedi, T.P., Murphy, W. M. (eds) AO priciples of fracture management. Stuttgart – New York, Thieme, 2000.

24. Smith, W. R., Moore, E. E., Osborn, P., Agudelo, J. F., Morgan, S. J., Parekh, A. A., Cothren, C. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and description of technique. J. Trauma, 59, 2005, 6, 1510–1514.

25. Stambaugh, L. E., Blackmore, C. C. Pelvic ring disruptions in emergency radiology. EJR, 48, 2003, 1, 71–87.

26. Tile, M., Helfet, D. L., Kellam, J. F. (eds) Fractures of the Pelvis and Acetabulum. 3rd edition. Philadelphia, Lippincott Williams & Wilkins, 2003.

27. Vyhnánek, F., Ducháč, V., Skála, P. Damage control laparotomie u tupého poranění břicha. Acta Chir. Orthop. Traumatol. Cech., 76, 2009, 4, 310–313.

Labels
Surgery Orthopaedics Trauma surgery
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#