Emergent management of the suspected pelvic fracture: challenges in the obese patient

2018 ◽  
Vol 164 (6) ◽  
pp. 432-435 ◽  
Author(s):  
Sarah K Stewart ◽  
M Khan
Keyword(s):  
Obese Patient ◽  
Pelvic Fracture ◽  
Independent Risk Factor ◽  
High Energy ◽  
Pelvic Fractures ◽  
Morbidity And Mortality ◽  
High Energy Trauma ◽  
Pelvic Binder ◽  
Trauma Population ◽  
Obese Population

Pelvic fractures, although infrequent, are a significant cause of morbidity and mortality in the trauma population. Currently, the mainstay of emergent management of a suspected pelvic fracture is placement of a pelvic binder, and their use in the prehospital setting is recommended for any individual involved in high-energy trauma. Obesity in the trauma patient has been shown to be an independent risk factor of morbidity and mortality, and the incidence of pelvic and lower extremity fractures has consistently demonstrated to be higher in the obese patient compared with an individual with a normal body habitus. This article aims to highlight the challenges associated with pelvic fracture in the obese population.

Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma

2021 ◽  
Author(s):  
Jonathan Hammerschlag ◽  
Yehuda Hershkovitz ◽  
Itamar Ashkenazi ◽  
Zahar Shapira ◽  
Igor Jeroukhimov
Keyword(s):  
High Energy ◽  
Pelvic Fractures ◽  
Contrast Extravasation ◽  
High Energy Trauma

Military experience in the management of pelvic fractures from OIF/OEF

2020 ◽  
pp. bmjmilitary-2020-001469
Author(s):  
William Parker ◽  
R W Despain ◽  
J Bailey ◽  
E Elster ◽  
C J Rodriguez ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Pelvic Fracture ◽  
External Fixator ◽  
Injury Severity ◽  
Fracture Pattern ◽  
Injury Pattern ◽  
Pelvic Fractures ◽  
Vertical Shear ◽  
Treatment Modalities ◽  
Pelvic Binder

IntroductionPelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.MethodsWe conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.ResultsOf 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.ConclusionsPelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

Pre-hospital and emergency department management of pelvic fractures and major trauma centre status: Has practice changed?

Trauma ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 207-211
Author(s):  
Jonathan Barnes ◽  
Philip Thomas ◽  
Ramsay Refaie ◽  
Andrew Gray
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Pelvic Fracture ◽  
Major Trauma ◽  
High Energy ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Major Trauma Centre ◽  
Initial Imaging ◽  
One Year

Introduction Pelvic fractures are indicative of high-energy injuries and carry a significant morbidity and mortality and pelvic binders are used to stabilise them in both the pre-hospital and emergency department setting. Our unit gained major trauma centre status in April 2012 as part of a national programme to centralise trauma care and improve outcomes. This study investigated whether major trauma centre status led to a change in workload and clinical practice at our centre. Methods A retrospective analysis of all patients admitted with a pelvic fracture for the six-month periods before, after and at one-year following major trauma centre status designation. Data were retrospectively collected from electronic patient records and binder placement assessed using an accepted method. Patients with isolated pubic rami fractures were excluded. Results Overall, 6/16 (37.5%) pelvic fracture admissions had a binder placed pre-major trauma centre status, rising to 14/34 (41.2%) immediately post-major trauma centre status and 22/32 (68.8%) ( p = 0.025) one year later. Binders were positioned accurately in 4 patients (80%, one exclusion) pre-major trauma centre status, 12 (92.4%) post-major trauma centre status and 22 (100%) at one year. CT imaging was the initial imaging used in 9 (56.3%) patients pre-major trauma centre status, 29 (85.3%) ( p = 0.04) post-major trauma centre status and 27 (84.4%) at one year. Discussion Pelvic fracture admissions doubled following major trauma centre status. Computed tomography, as the initial imaging modality, increased significantly with major trauma centre status, likely a reflection of the increased resources made available with this change. Although binder application rates did not change immediately, a significant improvement was seen after one year, with binder accuracy increasing to 100%. This suggests that although changes in clinical practice often do not occur immediately, with the increased infrastructure and clinical exposure afforded through centralisation of trauma services, they will occur, ultimately leading to improvements in trauma patient care.

scholarly journals A STUDY ON SKELETALLY IMMATURE UNSTABLE PELVIC FRACTURES IN CHILDREN

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Rakesh Kumar Gupta ◽  
Dr. Mohkam Singh
Keyword(s):  
Surgical Treatment ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Pelvic Ring ◽  
Health Centre ◽  
High Energy ◽  
Pelvic Fractures ◽  
Severe Bleeding ◽  
Fractures In Children ◽  
Unstable Fractures

Introduction: Out of all factures the pelvic facture showed relatively less which account for 3%. In children Pelvic fractures are relatively rare as less than 0.2% of all paediatric fractures and 1-5% of admissions to tertiary children’s health centre. Pelvis is a structure like a basin shaped bony which supports the spinal column and protects the abdominal organs. It may be facture due to high energy forces such as fall from a height or motor vehicle crash.  Incident of pelvic fracture is increasing and these are associated with a high mortality rate of 25%. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. When involving emergency situation cases with hemodynamic instability immediate treatment must be conducted using an external fixation, though it is only for temporarily to prioritise controlling the bleeding and saving the patient’s life. Aim: The main objective of this study is to study the surgical treatment for unstable pelvic fractures in children and stabilisation on basic primary care provided at an emergency service. Material and methods: In this study total 10 children patients were included who had suffered unstable fractures of the pelvic ring. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. This study was based on radiographic quantification and the outcome of the residual pelvic and after the surgery treatment using the method of Keshishyan et al[i] for comparison of pre and post operative findings. Result: In this study unstable fractures of the pelvic ring evaluated where female were 7 and male were 3 with the ration 7: 3. The ranges were 2 to 13 years with the mean age 7.2 years old. For all the patients operation was done on an average of 12.3 days after the facture. The maximum cases the initial traumas were due to the run over followed by motorcycle accident and fall from height respectively.  The injuries of the pelvis joint were divided inti anterior and posterior.  Symphysis disjucction of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. Unilateral fractures of the posterior ilium were also seen whereas unilateral anterior opening of the sacroiliac joint was also present. Conclusion: In children facture of pelvic ring is rare and an indication for surgical treatment is unusual.  Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Hence for the justification, this study finding provides justifies the option of surgical treatment for reduction and correction of pelvic deformities, of the pelvic ring at an early stage, at the time of the injury. Keywords: children, unstable pelvic facture, pelvic ring, Pelvic asymmetry

scholarly journals RECTAL CULTURE SURVEILLANCE AND DEVELOPED SYSTEMIC INFECTIONS IN VANCOMYCIN-RESISTANT ENTEROCOCCI AND CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE CARRIERS

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Çiğdem Arabacı ◽  
Salih Emre
Keyword(s):  
Pelvic Ring ◽  
High Energy ◽  
Pelvic Fractures ◽  
Young Age ◽  
Economic Losses ◽  
Severe Bleeding ◽  
Care Hospital ◽  
Age Group ◽  
High Energy Trauma ◽  
Unstable Fractures

Introduction: Globally, in the young age group of people mortality and morbidity is due to the high-energy trauma.  The losing of young age group of population will get impact in the social economic losses of family as well as the nation. Fractures are generally caused by high-energy trauma, high-impact accidents and are often associated with injuries to other organic lesions like abdominal viscera, genitourinary system, neurovascular, musculoskeletal structures and central nervous system. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. Aim: The main objective of this study is to study of Unstable Pelvic Fractures from children in tertiary care hospital Material and methods: In this study total 10 patients were included who had suffered unstable fractures of the pelvic ring with the age from  1 to 15 years old.. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. Result: In this study total 10 patients were included with unstable fractures of the pelvic ring evaluated where female were 6 and male were 4 with the ration 6: 4. The age ranges were 2 to 15 years with the mean age 7.5±4 years old. Symphysis disjunctions of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. The AO-OTA classification was used to evaluate the cases with the following distribution as 61 B1 (one case); 61 B2 (one case); 61 C3 (one cases), 61 C2 (one case) and 61 C1 (seven cases). Conclusion: Now  a day’s also many research which still have a controversy  for treatment,  which  has  been  recommended  for  treating  these  fractures  for  many  years. Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Keywords:  unstable pelvic facture, pelvic asymmetry, children

Basic Management of Pelvic Fractures

2017 ◽  
Author(s):  
Amelia Simpson ◽  
Raul Coimbra ◽  
Todd W Costantini
Keyword(s):  
Pelvic Fracture ◽  
Clinical Status ◽  
Balloon Occlusion ◽  
Pelvic Fractures ◽  
Trauma Surgeon ◽  
Hemorrhage Control ◽  
Pelvic Fixation ◽  
Fracture Stabilization ◽  
Pelvic Binder ◽  
Endovascular Balloon Occlusion

The management and treatment of complex pelvic fractures require knowledge of the initial evaluation of a trauma patient, pertinent anatomy, and techniques available for hemorrhage control. Trauma patients with complex pelvic fractures are at high risk for hemorrhage and require thoughtful and expeditious management. A multidisciplinary team including a trauma surgeon, an orthopedic surgeon, and an interventional radiologist is required for optimal treatment of these complex injuries. The team must be managed by the trauma surgeon to guide ongoing resuscitation as the patient may travel throughout the hospital to undergo several interventions to control hemorrhage. A number of techniques can be emergently implemented for fracture stabilization and hemorrhage control, including temporary application of a pelvic binder, preperitoneal pelvic packing, external fixation, and angioembolization. The patient’s clinical status, fracture pattern, and bleeding source must be considered when deciding which hemorrhage control techniques should be performed. New temporary hemorrhage control interventions, such as resuscitative endovascular balloon occlusion of the aorta, have shown early success in control of pelvic fracture–related hemorrhage and require further investigation. Pelvic fractures are associated with a number of neurovascular and genitourinary injuries, which can carry long-term morbidity. This review discusses the diagnosis, management, and treatment of complex pelvic fracture and associated hemorrhage. This review contains 5 figures, and 55 references.  Key words: angioembolization, pelvic fixation, pelvic fracture, preperitoneal packing, resuscitative endovascular balloon occlusion of the aorta

Pelvic Binders in Trauma Patients - Are We Doing it Right?

2021 ◽  
Author(s):  
Sush Ramakrishna Gowda
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Pelvic Binder ◽  
Major Trauma Centre ◽  
Fracture Management ◽  
Education And Awareness ◽  
Pelvic Fracture Management ◽  
And Training

Introduction: Pelvic fractures from high-energy trauma require immediate stabilisation to avoid significant morbidity and mortality. When applied correctly over the level of the greater trochanters (GT) pelvic binders provide adequate stabilisation of unstable pelvic fractures. The aim of this study was to identify the accuracy of placement of pelvic binders in patients presenting to the local Major Trauma Centre (MTC). Methods: A retrospective study was carried out to assess the level of the pelvic binders in relation to the greater trochanters of the patient-classified as optimal or sub-optimal. Results: An initial review of the computed tomography (CT) trauma series in 28 consecutive patients with pelvic binders revealed that more than 50% of the pelvic binders were placed above the level of the GT, reducing the efficacy of the pelvic binders. A regional educational and training day was held with a focus on pelvic fracture management. Following this, a review was conducted on the placement of the pelvic binder in 100 consecutive patients. This confirmed a significant improvement in the position of the pelvic binder by over 70%. Conclusion: Inaccurately positioned pelvic binders provided suboptimal stabilisation of pelvic fractures. With education and awareness, there has been an improvement in the accuracy of pelvic binder placement in trauma patients. This study has highlighted the need for regular audit of current practice, in combination with regular education and training.

scholarly journals Predictors of Acute Mortality After Open Pelvic Fracture: Experience From 37 Patients From A Level I Trauma Center

2020 ◽  
Vol 44 (11) ◽  
pp. 3737-3742
Author(s):  
I-Chuan Tseng ◽  
I-Jung Chen ◽  
Ying-Chao Chou ◽  
Yung-Heng Hsu ◽  
Yi-Hsun Yu
Keyword(s):  
Logistic Regression ◽  
Mortality Rate ◽  
Pelvic Fracture ◽  
Area Under The Curve ◽  
High Energy ◽  
Pelvic Fractures ◽  
Youden Index ◽  
Revised Trauma Score ◽  
Level I ◽  
Resuscitated Patients

Abstract Background Open pelvic fractures are caused by high-energy traumas and are accompanied by organ injuries. Despite improvements in pre-hospital care, the acute mortality rate following open pelvic fractures remains high. This study aimed to report experiences in managing open pelvic fractures, identify potential independent predictors that contribute to acute mortality in such patients, and generate a scoring formula to predict mortality rate. Methods Open pelvic fracture patients managed during a 42-month period were retrospectively studied. Logistic regression analysis was used to determine predictors of acute mortality. Using the Youden index, threshold values of predictors were selected. Significant predictors were weighted to create a scoring formula. The area under the curve (AUC) was tested in this specific group. Results The incidence of open pelvic fractures in all pelvic fractures was 4.9% (37/772), and the overall mortality rate was 21.6% (8/37). All the successfully resuscitated patients entered the reconstruction stage survived and underwent the complete treatment course. Univariate and multivariate logistic regression analyses revealed that the revised trauma score (RTS) was the single independent predictor of acute mortality. A scoring formula was generated following the statistical analysis. The probability of mortality was 0% and 100% when the score was above and below −2, respectively. This model predicted mortality with an AUC of 0.948 (95% confidence interval 0.881–1.000, P < 0.01). Conclusion The RTS may be a potential predictor of acute mortality in open pelvic fracture patients. Further work would be required to validate the clinical efficacy of the generated scoring formula.

scholarly journals An overview of the key principles and guidelines in the management of pelvic fractures

2020 ◽  
pp. 175045892094735
Author(s):  
Ahmed M H A M Mostafa ◽  
Harry Kyriacou ◽  
Mukai Chimutengwende-Gordon ◽  
Wasim S Khan
Keyword(s):  
Chronic Pain ◽  
Postoperative Complications ◽  
Pelvic Fracture ◽  
Psychological Health ◽  
Surgical Techniques ◽  
Pelvic Fractures ◽  
Morbidity And Mortality ◽  
Sexual And Urinary Dysfunction ◽  
Mechanism Of Trauma ◽  
Complex Injuries

Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient’s journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.

scholarly journals A Traumatic Direct Inguinal Hernia from Pelvic Ring Disruption

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Kevin L. Chow ◽  
Eduardo Smith-Singares ◽  
James Doherty
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Wall ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Abdominal Wall Reconstruction ◽  
High Energy ◽  
Pelvic Fractures ◽  
Open Book ◽  
Direct Inguinal Hernia ◽  
Muscle Fascia

Introduction. Pelvic fractures usually involve a high-energy traumatic mechanism and account for approximately 3% of all blunt traumatic skeletal injuries. Additional musculoskeletal injuries are found in over 80% of unstable pelvic fractures. Traumatic abdominal wall hernias (TAWHs) are a rare entity, and traumatic inguinal hernias (TIHs) associated with open-book pelvic fractures have not been described previously.Case Presentation. We present the case of a 45-year-old male motorcyclist involved in a collision resulting in a traumatic direct inguinal hernia due to abdominal wall disruption from an open-book pelvic fracture. He underwent a combined operation with an open reduction and internal fixation (ORIF) of his pelvic fracture and an abdominal wall reconstruction with a modified Stoppa technique utilizing mesh for his hernia.Discussion. This is a unique presentation of a TIH due to an open-book pelvic fracture after blunt abdominal trauma. The formation of TAWH is typically from a combination of local tangential shearing forces and a sudden rise in intraabdominal pressures damaging the muscle, fascia, and peritoneum while the skin remains intact. In patients without hollow viscous injuries and gross contamination, these hernias can be repaired safely with mesh in the acute setting simultaneously with pelvic reduction.

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