Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review

Aims This study aimed to analyze the correlation between transverse process (TP) fractures of the fourth (L4) and fifth (L5) lumbar vertebrae and biomechanical and haemodynamic stability in patients with a pelvic ring injury, since previous data are inconsistent. Patients and Methods The study is a retrospective matched-pair analysis of patients with a pelvic fracture according to the modified Tile AO Müller and the Young and Burgess classification who presented to a level 1 trauma centre between January 2005 and December 2014. Results A total of 728 patients with pelvic ring injuries were included, of whom 183 (25.1%) had a biomechanically unstable pelvic fracture. Of these patients, 84 (45.9%) had a fracture of a TP of L4 and/or L5. A total of 73 patients (13.4%) with a stable pelvic ring injury (p < 0.001) had a fracture of a TP. Patients with a fracture of a TP of L4 and/or L5 had a 5.5-fold risk (odds ratio (OR)) of having a biomechanically unstable pelvic injury. TP fractures (OR 1.6, p = 0.2) could not be confirmed as an independent predictor of haemodynamic instability. Conclusion This is the first study that has demonstrated a positive correlation between a TP fracture of L4 and/or L5 and a biomechanically unstable pelvic ring injury. The presence of transverse process fractures of L4 and/or L5 indicates increased severity of pelvic injury and therefore can help in the planning of emergency treatment. Cite this article: Bone Joint J 2018;100-B:1214–19.

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Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-03167-x ◽

2021 ◽

Author(s):

Abdulrahman Al-Naseem ◽

Abdelrahman Sallam ◽

Ahmed Gonnah ◽

Omar Masoud ◽

Muhammad M. Abd-El-Barr ◽

...

Keyword(s):

Systematic Review ◽

Screw Fixation ◽

Pelvic Ring ◽

Meta Analysis ◽

Robot Assisted ◽

Posterior Pelvic Ring ◽

Sacroiliac Screw ◽

Pelvic Ring Injuries ◽

Sacroiliac Screw Fixation

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Experience of application of extraperitoneal pelvic packing in unstable pelvic ring injuries

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-4-44-47 ◽

2017 ◽

Vol 176 (4) ◽

pp. 44-47 ◽

Cited By ~ 1

Author(s):

I. M. Samokhvalov ◽

I. V. Kazhanov ◽

V. A. Manukovskiy ◽

A. N. Tulupov ◽

S. I. Mikityuk ◽

...

Keyword(s):

Pelvic Ring ◽

Critical Conditions ◽

Intravenous Contrast ◽

Severe Injuries ◽

Pelvic Packing ◽

Mechanical Stabilization ◽

Pelvic Ring Injuries ◽

Results Of Treatment ◽

Pelvic Stabilization ◽

Unstable Pelvic Ring Injuries

OBJECTIVE. Clinical efficacy of extraperitoneal pelvic packing for hemostasis was assessed in patients with unstable pelvic ring injuries and signs of unstable hemodynamics. MATERIAL AND METHODS. The results of treatment were analyzed in 19 patients with hemodynamically unstable pelvic ring injuries. Extraperitoneal pelvic packing was applied in order to stop bleeding after mechanical pelvic stabilization. The evaluation of hemostasis efficacy was performed by using computerized helical tomography with intravenous contrast. RESULTS. The extraperitoneal pelvic packing allowed doctors to achieve stop of bleeding in 14 (73,7 %) patients. CONCLUSIONS. Complex of mechanical stabilization and extraperitoneal pelvic packing of damaged pelvic ring could be actively used in cases of severe injuries for victims in critical conditions.

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Secondary Angio-Embolization After Emergent Pelvic Stabilization and Pelvic Packing Is a Safe Option for Patients With Persistent Hemorrhage From Unstable Pelvic Ring Injuries

Frontiers in Surgery ◽

10.3389/fsurg.2020.601140 ◽

2020 ◽

Vol 7 ◽

Author(s):

Thomas Lustenberger ◽

Philipp Störmann ◽

Kathrin Eichler ◽

Christoph Nau ◽

Maren Janko ◽

...

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Pelvic Ring ◽

Pelvic Packing ◽

Superior Gluteal Artery ◽

Obturator Artery ◽

Pelvic Ring Injuries ◽

Internal Iliac ◽

Pelvic Stabilization ◽

Mean Time

Introduction: In patients with severe pelvic ring injuries, exsanguination still is the leading cause of death in the early post-injury phase. While mechanical pelvic ring stabilization and pre-peritoneal pelvic packing are mainly addressing venous bleeding, angio-embolization aims to control arterial bleeding. The goal of the present study was to evaluate the rate of postoperative angio-embolization after mechanical pelvic ring injury stabilization and pre-peritoneal pelvic packing. Bleeding sources detected in the angiography and the patient's outcome were investigated.Patients and Methods: Retrospective observational cohort study at a single academic level I trauma center, reviewing all patients with pelvic ring injuries admitted from 01/2010 to 12/2019. Patients with emergent mechanical pelvic ring stabilization (supraacetabular external fixator and/or pelvic C-clamp) and direct pre-peritoneal pelvic packing were further analyzed. Patients that underwent postoperative angio-embolization were compared with those that did not. All postoperative angio-embolizations were evaluated with regards to bleeding sources and type of embolization.Results: During the study period, a total of 39 patients required immediate mechanical pelvic stabilization and direct pre-peritoneal pelvic packing. Of these, 12 patients (30.8%) underwent a postoperative angio-embolization. The following vessels were identified as bleeding sources: superior gluteal artery (n = 6), obturator artery (n = 2), internal pudendal artery (n = 2), unnamed branches of the internal iliac artery (n = 3). A selective embolization was successful in 11 patients; in 1 patient, an unilateral complete occlusion of the internal iliac artery was performed to control the bleeding. Mean time from hospital admission to the surgical procedure was 52.8 ± 14.7 min and the mean time from admission to angio-embolization was 189.1 ± 55.5 min. The in-hospital mortality rate of patients with angio-embolization was 25.0% (n = 3). Of these, 2 patients died due to multiple organ failure and 1 patient due to severe head injury.Conclusion: Secondary angio-embolization after external pelvic fixation and pre-peritoneal pelvic packing was effective in controlling ongoing bleeding. The most frequently detected bleeding vessel was the superior gluteal artery, which is difficult to surgically address, further highlighting the importance of angio-embolization in the management algorithm.

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Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.06.039 ◽

2020 ◽

Vol 11 (6) ◽

pp. 970-975

Author(s):

Chetan Kumbhare ◽

Sanjay Meena ◽

Kulbhushan Kamboj ◽

Vivek Trikha

Keyword(s):

Systematic Review ◽

Pelvic Ring ◽

Pelvic Ring Injuries

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Mobilization versus displacement on lateral stress radiographs for determining operative fixation of minimally displaced lateral compression type I (LC1) pelvic ring injuries

International Orthopaedics ◽

10.1007/s00264-020-04912-3 ◽

2021 ◽

Author(s):

Joshua A. Parry ◽

Motasem Salameh ◽

August Funk ◽

Austin Heare ◽

Stephen C. Stacey ◽

...

Keyword(s):

Pelvic Ring ◽

Type I ◽

Lateral Stress ◽

Lateral Compression ◽

Stress Radiographs ◽

Pelvic Ring Injuries ◽

Operative Fixation ◽

Compression Type

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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

International Orthopaedics ◽

10.1007/s00264-021-05153-8 ◽

2021 ◽

Author(s):

Giuseppe Rovere ◽

Andrea Perna ◽

Luigi Meccariello ◽

Domenico De Mauro ◽

Alessandro Smimmo ◽

...

Keyword(s):

Sexual Dysfunction ◽

Sexual Function ◽

Pelvic Fracture ◽

Pelvic Ring ◽

Pelvic Fractures ◽

Sexual Dysfunctions ◽

Fracture Type ◽

Ring Fracture ◽

Male And Female ◽

Pelvic Ring Injuries

Abstract Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

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