UNSTABLE PELVIC FRACTURES AND HEMORRHAGE – INITIAL MANAGEMENT
Authors:
Peter Rovder+ 1 2; Valér Džupa+ 1 3; Miroslav Lisý+ 1 4; Jana Chmelová+ 1 5; Robert Grill+ 1 6; Václav Báča+ 1 7; Michal Fric+ 1 8
Authors‘ workplace:
Centrum pro integrované studium pánve 3. LF UK, Praha
1; Oddelenie úrazovej chirurgie NsP Štefana Kukuru, Michalovce
2; Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha-Vinohrady
3; Ortopedická klinika LF UK a FN, Bratislava-Ružinov
4; Radiodiagnostický ústav FNsP Ostrava
5; Urologická klinika 3. LF UK a FNKV, Praha-Vinohrady
6; Ústav anatomie 3. LF UK, Praha
7; Klinika anesteziologie a resuscitace 3. LF UK a FNKV, Praha-Vinohrady
8
Published in:
Úraz chir. 14., 2006, č.3
Overview
Purpose:
Pelvic fractures are severe injuries. The purpose of this study is to determinate diagnostictherapeutical process in patients after complex pelvic injury associated with significant hemorrhage in the initial care in hospital.
Methods:
In the paper are noticed diagnostic modalities and algorithm of primary treatment management in patients with unstable pelvic injury.
Conclusions:
In cases with pelvic instability and haemodynamic instability is necessery to apply emergency protocol based on pelvic stabilisation together with surgical haemostasis by pelvic tamponade.
Key words:
pelvic ring injury, emergency treatment, Cclamp, pelvic tamponade.
Sources
1. Archdeacon, M.T., Hiratzka, J. The trochanteric Cclamp for provisional pelvic stability. J Orthop Trauma. 2006, 20, s. 47–51.
2. BARTLETT, C., ASPRINIO, D., LUIS, S., HELFET, D. Intrapelvic dislocation of the left hemipelvis as a complication of the pelvic „C“ clamp: A case report and review. J Orthop Trauma. 1997, 11, s. 540–542.
3. Bassam, D., Cephas, G.A., Ferguson, K.A. et al. A protocol for the initial management of unstable pelvic fractures. Am Surg. 1998, 64, s. 862–867.
4. BOTTLANG, M., KRIEG, J.C., MOHR, M. et al. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg. 2002, 84A, suppl 2, s. 43–47.
5. BOTTLANG, M., SIMPSON, T., SIGG, J. et al. Noninvasive reduction of openbook pelvic fractures by circumferential compression. J Orthop Trauma. 2002, 16, s. 367–373.
6. CULEMANN, U., TOSOUNIDIS, G., REILMANN, H. et al. Beckenringverletzung. Diagnostik und aktuelle Behandlungsmöglichkeiten. Chirurg. 2003, 74, s. 687–700.
7. DAY, A.C. Emergency management of pelvic fractures. Hosp Med. 2003, 64, s. 79–86.
8. EASTRIDGE, B.J., STARR, A., MINEI, J.P. et al. The importance of fracture pattern inguiding therapeutic decisionmaking in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002, 53, s. 446–451.
9. Geusens, E., Brys, P., Maleux, G. et al. Imaging in pelvic trauma. JBRBTR. 2000, 83, s. 173–180.
10. GOURLAY, D., HOFFER, E., ROUTT, M. et al. Pelvic angiography for recurrent traumatic pelvic arterial hemorhage. J Trauma. 2005, 59, s. 1168–1174.
11. Grotz, M.R.W., Allami, M.K., Harwood, P. et al. Open pelvic fractures: Epidemiology, current concepts of management and outomes. Injury. 2005, 36, s. 1–13.
12. GRUEN, G.S., LEIT, M.E., GRUEN, R.J. et al. The acute management of hemodynamically ustable multiple trauma patients with pelvic ring fractures. J Trauma. 1994, 36, s. 706–713.
13. GUMANENKO, E.K., SHAPOVALOV, B.M., DULAEV, A.K. et al. Current approaches to the treatment of casualties with unstable pelvic ring. (in Russian) Voen Med Zh. 2003, 324, s. 17–24.
14. KRIEG, J.C., MOHR, M., ELLIS T.J. et al. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: A clinical trial. J Trauma. 2005, 59, s. 659–664.
15. Kushimoto, S., Masatoku, A, Aiboshi, J. et al. The role of interventional radiology in patients requiring Damage Control Laparotomy. J Trauma. 2003, 54, s. 171–176.
16. LINDAHL, J., HIRVENSALO, E., BÖSTMAN, O. et al. Failure of reduction with an external fixator in the management of injuries of the pelvic ring. J Bone Joint Surg. 1999, 81B, s. 955–962.
17. MICHEK, J., ZELNÍČEK, P.,WENDSCHE, P. et al. Pánevní kompartment syndrom. Úraz Chir. 2000, 8, s. 24–29.
18. Miller, P.R., Moore, P.S., Mansell, E. et al. External fixation or arteriogram in bleeding pelvic fracture: Initial therapy guided by markers of arterial hemorrhage. J Trauma. 2003, 54, s. 437–443.
19. MIRZA, A., ELLIS, T. Initial management of pelvic and femoral fractures in the multiply injured patient. Crit Care Clin. 2004, 20, s. 159–170.
20. MOHANTY, K., MUSSO, D., POWELL, J.N. et al. Emergent management of pelvic ring injuries: an update. Can J Surg. 2005, 48, s. 49–56.
21. OLSON, S.A., RHORER, A.S. Orthopaedic trauma for the general orthopaedist. Clin Orthop. 2005, 433, s. 30–37.
22. Pavelka, T., Džupa, V., Štulík, J. et al. Výsledky operační léčby nestabilního poranění pánevního kruhu. Acta Chir Orthop Traumatol Čech. v tisku.
23. POHLEMANN, T. Pelvic ring injuries: Assessment and concepts of surgical management. In: RÜEDI, T.P., MURPHY, W.M. (Eds). AO priciples of fracture management. Stuttgart – New York: Thieme. 2000, s. 394–417.
24. POHLEMANN, T., GÄNSSLEN, A., TSCHERNE, H. Fractures and dislocations of the pelvic ring. In: Surgical techniques in orthopaedics and traumatology. Paris: Elsevier SAS. 2000, 11s.
25. POHLEMANN, T., BRAUNE, C., GÄNSSLEN, A. et al. Pelvic emergency clamps: Anatomic landmarks for a safe primary application. J Orthop Trauma. 2004, 18, s. 102–105.
26. POHLEMANN, T., CULEMAN, U., TOSOUNIDIS, G. et al. Die Anlage der NotfallBeckenzwinge. Unfallchirurg. 2004, 107, s. 1185–1191.
27. PRYOR, J.P., REILLY, P.M. Initial care of the patient with blunt polytrauma. Clin Orthop. 2004, 422, s. 30–36.
28. Sarin, E.L., Moore, J.B., Moore, E.E. et al. Pelvic fracture pattern does not always predict the need for urgent embolization. J Trauma. 2005, 58, s. 973–977.
29. SMITH, W.R., MOORE, E.E., OSBORN, P. et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and description of technique. J Trauma. 2005, 59, s. 1510–1514.
30. Stambaugh, L.E., Blackmore, C.C. Pelvic ring disruptions in emergency radiology. Eur J Radiol. 2003, 48, s. 71–87.
31. STILETTO, R.J., BAACKE, M., GOTZEN L. Comminuted pelvic ring disruption in toddlers: Management of a rare injury. J Trauma. 2000, 48, s. 161–164.
32. ŠIMKO, P. Zlomeniny acetábula. Bratislava: Slovak Academic Press, 1998. 142 s.
33. TIEMANN, A.H., SCHMIDT, C., GONSCHOREK, O. et al. Notfallbehandlung instabiler Beckenfrakturen – Stellenwert der „Beckenzwinge“. Zentralbl Chir. 2004, 129, s. 245–251.
34. TILE, M. Editorial. The management of unstable injuries of the pelvic ring. J Bone Joint Surg. 1999, 81B, s. 941–943.
35. TILLE, M., HELFET, D.L., KELLAM, J.F. (Eds). Fractures of the pelvis and acetabulum. 3rd edition. Philadelphia: Lippincott Williams & Wilkins, 2003. 830 s.
36. VAN VUGT, A.B., VAN KAMPEN, A. An unstable pelvic ring. The killing fracture. J Bone Joint Surg. 2006, 88B, s. 427–433.
37. VERMEULEN, B., PETER, R., HOFFMEYER, P. et al. Prehospital stabilization of pelvic dislocations: A new strap belt to provide temporary hemodynamic stabilization. Swiss Surg. 1999, 5, s. 43–46.
38. WOLINSKY, P.R. Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin North Am. 28, 1997, 3, s. 321–329.
Labels
Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
2006 Issue 3
Most read in this issue
- DIFFICULTIES IN ARTHROSCOPIC RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT USING M. SEMITENTINOSUS TENDON WITH ENDOBUTTON FIXATION – SIX YEAR EXPERIENCES
- UNSTABLE PELVIC FRACTURES AND HEMORRHAGE – INITIAL MANAGEMENT
- Influence of mechanical factors to the later result of recostruction of the anterior cruciate ligament
- Kinematic navigation for anterior cruciate ligament reconstruction