scholarly journals Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?

2021 ◽  
Vol 10 (6) ◽  
pp. 1297
Author(s):  
Valerie Kuner ◽  
Nicole van Veelen ◽  
Stephanie Studer ◽  
Bryan Van de Wall ◽  
Jürgen Fornaro ◽  
...  
Keyword(s):  
Clinical Education ◽  
Trauma Center ◽  
Pelvic Ring ◽  
Daily Practice ◽  
Pelvic Trauma ◽  
Fracture Pattern ◽  
Pelvic Fractures ◽  
Unstable Fracture ◽  
Associated Injuries ◽  
Resuscitation Room

Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.

Pelvic ring fractures: assessment, associated injuries, and acute management

2011 ◽  
Author(s):  
John McMaster
Keyword(s):  
Soft Tissue ◽  
Pelvic Ring ◽  
Fracture Pattern ◽  
Pelvic Fractures ◽  
Acute Management ◽  
Associated Injuries ◽  
Successful Management ◽  
Pelvic Ring Fractures ◽  
Advance Planning

♦ The contribution of the soft tissue and bone in each fracture pattern must be understood♦ A large proportion of pelvic fractures will have significant associated injuries♦ Successful management of haemodynamically unstable pelvic fractures requires advance planning.

scholarly journals A Delayed and Rather Unusual Presentation of a Bladder Injury after Pelvic Trauma: 5 Years after a Road Traffic Accident

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Nikolaos Davarinos ◽  
John Thornhill ◽  
JP McElwain ◽  
David Moore
Keyword(s):  
Traffic Accident ◽  
Road Traffic ◽  
High Energy ◽  
Pelvic Trauma ◽  
Careful Consideration ◽  
Pelvic Fractures ◽  
Unusual Presentation ◽  
Systematic Evaluation ◽  
Bladder Injury ◽  
Associated Injuries

Associated injuries frequently occur in patients who sustain fractures of the pelvis. Specifically, high-energy trauma resulting in pelvic fractures places the bladder and urethra at risk for injury, often resulting in significant complications. Timely identification and management of genitourinary injuries minimize associated morbidity. Prompt injury identification depends upon a systematic evaluation with careful consideration of the mechanism of injury. Physical examination is pertinent as well as analysis of the urine and appropriate diagnostic imaging. Despite such increased vigilance genitourinary injuries get missed and delayed presentations in the order of a few weeks have been well documented. To our knowledge, this is the first report of its kind in the literature showing such a particularly delayed (5 years) and rather unusual presentation of a bladder injury after pelvic trauma.

scholarly journals Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

2020 ◽  
Author(s):  
Yu-Tung Wu ◽  
Chi-Tung Cheng ◽  
Yu-San Tee ◽  
Chih-Yuan Fu ◽  
Chien-Hung Liao ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Injury Severity ◽  
Pelvic Trauma ◽  
Fracture Pattern ◽  
Pelvic Fractures ◽  
Pelvic Injury ◽  
Vascular Injuries ◽  
Total Hospital ◽  
Total Hospital Stay

Abstract Background: The most common cause of death in cases of pelvic trauma is exsanguination caused by associated injuries but not the pelvic injury per se. For patients with relatively isolated pelvic trauma, the impact of the vascular injury severity on the outcome remains unclear. We hypothesized that, in addition to the fracture pattern complexity, the severity of the pelvic vascular injury plays a more decisive role in the outcome. Methods: The medical records of patients with pelvic fracture at a single center between Jan 2016 and Dec 2017 were retrospectively reviewed. Those with an abbreviated injury scale (AIS) score ≥3 in areas other than the pelvis were excluded. Lateral compression (LC) type 1 fractures and anteroposterior compression (APC) type 1 fractures according to the Young-Burgess classification and ischial fractures were defined as simple pelvic fractures, while other fracture types were considered complicated pelvic fractures. Based on CT, the vascular injury severity was defined as minor (fracture with or without hematoma) or severe (hematoma with contrast pooling/extravasation). The patient demographics, clinical parameters, and outcome measures were compared between the groups. Results: Twenty-six of the 155 patients had a severe vascular injury. Those with severe vascular injuries had poorer hemodynamics, a higher injury severity score (ISS), required more blood transfusions, and had a longer ICU stay (3.81 vs. 0.86 days, p=0.000) and total hospital stay (20.7 vs. 10.1 days, p=0.002) than those with minor vascular injuries. In contrast, those with complicated pelvic fractures (LC II/III, APC II/III, vertical shear and combined type fracture) required a similar number of transfusions and had a similar length of ICU stay compared to those with simple pelvic fractures (LC I, APC I and ischium fracture), but they had a longer total hospital stay (13.6 vs. 10.3 days, p=0.034). These findings were similar even if only patients with an ISS >=16 were considered. Conclusions: Our results indicate that even in patients with relatively isolated pelvic injuries, the vascular injury severity is more closely correlated to the outcome than the type of anatomical fracture. Therefore, a more balanced classification of pelvic injury that takes both the fracture pattern and hemodynamic status into consideration, such as the WSES classification, seems to have better utility for clinical practice.

Pediatric Pelvic Fractures: A Marker for Injury Severity

2006 ◽  
Vol 72 (6) ◽  
pp. 481-484 ◽  
Author(s):  
Lisa Spiguel ◽  
Loretto Glynn ◽  
Donald Liu ◽  
Mindy Statter
Keyword(s):  
Pelvic Fracture ◽  
Trauma Center ◽  
Motor Vehicle ◽  
Pediatric Trauma ◽  
Operative Management ◽  
Pelvic Fractures ◽  
Associated Injuries ◽  
Level I ◽  
The University ◽  
Pediatric Trauma Center

Pelvic fractures comprise a small number of annual Level I pediatric trauma center admissions. This is a review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures. This is a retrospective review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures during the 12-year period from 1992 to 2004. From 1992 to 2004, there were 2850 pediatric trauma admissions. Thirteen patients were identified with pelvic fractures; seven were boys and six were girls. The average age was 8 years old. The mechanism of injury in all cases was motor vehicle related; 11 patients (87%) sustained pedestrian-motor vehicle crashes. According to the Torode and Zeig classification system, type III fractures occurred in eight patients (62%) and type IV fractures occurred in six patients (31%). Associated injuries occurred in eight patients (62%). Seven of these patients (88%) had associated injuries involving two or more organ systems. Of the associated injuries, additional orthopedic injuries were the most common, occurring in 62 per cent of our patients. Neurological injuries occurred in 54 per cent of patients, vascular injuries in 39 per cent, pulmonary injuries in 31 per cent, and genitourinary injuries in 15 per cent. Five patients (38%) were treated operatively; only two patients underwent operative management directly related to their pelvic fracture. The remaining three patients underwent operative management of associated injuries. The mortality rate was 0 per cent. Although pelvic fractures are an uncommon injury in pediatric trauma patients, the morbidity associated with these injuries can be profound. The majority of pelvic fractures in children are treated nonoperatively, however, more than one-half of these patients have concomitant injuries requiring operative management. When evaluating and treating pediatric pelvic fractures, a systematic multidisciplinary approach must be taken to evaluate and prioritize the pelvic fracture and the associated injuries.

scholarly journals Management of Hemodynamically Unstable Pelvic Ring Fractures

2020 ◽  
Vol 7 ◽  
Author(s):  
Kim E. M. Benders ◽  
Luke P. H. Leenen
Keyword(s):  
Pelvic Ring ◽  
Treatment Algorithm ◽  
High Energy ◽  
Pelvic Trauma ◽  
Pelvic Fractures ◽  
Origin Time ◽  
Pelvic Packing ◽  
Pelvic Ring Fractures ◽  
Primary Means ◽  
Set Up

Hemodynamically unstable pelvic fractures are challenging high-energy traumas. In many cases, these severely injured patients have additional traumatic injuries that also require a trauma surgeon's attention. However, these patients are often in extremis and require a multidisciplinary approach that needs to be set up in minutes. This calls for an evidence-based treatment algorithm. We think that the treatment of hemodynamically unstable pelvic fractures should primarily involve thorough resuscitation, mechanical stabilization, and preperitoneal pelvic packing. Angioembolization should be considered in patients that remain hemodynamically unstable. However, it should be used as an adjunct, rather than a primary means to achieve hemodynamic stability as most of the exsanguinating bleeding sources in pelvic trauma are of venous origin. Time is of the essence in these patients and should therefore be used appropriately. Hence, the hemodynamic status and physiology should be the driving force behind each decision-making step within the algorithm.

scholarly journals Clinical characteristics, injury pattern and management of pediatric pelvic fracture: An observational retrospective study from a level I trauma center

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Abduljabbar Alhammoud ◽  
Isam Moghamis ◽  
Husham Abdelrahman ◽  
Syed Imran Ghouri ◽  
Mohammad Asim ◽  
...  
Keyword(s):  
Trauma Center ◽  
Clinical Characteristics ◽  
Pelvic Ring ◽  
Injury Pattern ◽  
Pelvic Fractures ◽  
Type I ◽  
Conservative Group ◽  
Triradiate Cartilage ◽  
Type Iv ◽  
Level I

Abstract Background Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center. Methods This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I–IV), open versus closed triradiate cartilage, and surgical versus non-surgical management. Results During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%. Conclusion PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF.

scholarly journals Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

2020 ◽  
Author(s):  
Yu-Tung Wu ◽  
Chi-Tung Cheng ◽  
Yu-San Tee ◽  
Chih-Yuan Fu ◽  
Chien-Hung Liao ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Injury Severity ◽  
Pelvic Trauma ◽  
Fracture Pattern ◽  
Pelvic Fractures ◽  
Pelvic Injury ◽  
Vascular Injuries ◽  
Total Hospital ◽  
Total Hospital Stay

Abstract Background: The most common cause of death in cases of pelvic trauma is exsanguination caused by associated injuries, not the pelvic injury itself. For patients with relatively isolated pelvic trauma, the impact of vascular injury severity on outcome remains unclear. We hypothesized that the severity of the pelvic vascular injury plays a more decisive role in outcome than fracture pattern complexity. Methods: Medical records of patients with pelvic fracture at a single center between Jan 2016 and Dec 2017 were retrospectively reviewed. Those with an abbreviated injury scale (AIS) score ≥3 in areas other than the pelvis were excluded. Lateral compression (LC) type 1 fractures and anteroposterior compression (APC) type 1 fractures according to the Young-Burgess classification and ischial fractures were defined as simple pelvic fractures, while other fracture types were considered complicated pelvic fractures. Based on CT, vascular injury severity was defined as minor (fracture with or without hematoma) or severe (hematoma with contrast pooling/extravasation). Patient demographics, clinical parameters, and outcome measures were compared between the groups.Results: Severe vascular injuries occurred in 26 of the 155 patients and were associated with poorer hemodynamics, a higher injury severity score (ISS), more blood transfusions, and a longer ICU stay (3.81 vs. 0.86 days, p=0.000) and total hospital stay (20.7 vs. 10.1 days, p=0.002) compared with minor vascular injuries. By contrast, those with complicated pelvic fractures (LC II/III, APC II/III, vertical shear and combined type fracture) required a similar number of transfusions and had a similar length of ICU stay as those with simple pelvic fractures (LC I, APC I and ischium fracture) but had a longer total hospital stay (13.6 vs. 10.3 days, p=0.034). These findings were similar even if only patients with ISS >=16 were considered.Conclusions: Our results indicate that even in patients with relatively isolated pelvic injuries, vascular injury severity is more closely correlated to outcome than the type of anatomical fracture. Therefore, a more balanced classification of pelvic injury that takes both the fracture pattern and hemodynamic status into consideration, such as the WSES classification, seems to have better utility for clinical practice.Trial registration: This is a retrospective review study, not a clinical trial.

Pelvic Impairments

2018 ◽  
Vol 23 (4) ◽  
pp. 9-10
Author(s):  
James Talmage ◽  
Jay Blaisdell
Keyword(s):  
Pelvic Ring ◽  
Reproductive Organs ◽  
High Impact ◽  
Pelvic Fractures ◽  
Motor Dysfunction ◽  
Impact Event ◽  
Concomitant Injuries ◽  
Rating Process ◽  
Pass Through ◽  
A Minor

Abstract Pelvic fractures are relatively uncommon, and in workers’ compensation most pelvic fractures are the result of an acute, high-impact event such as a fall from a roof or an automobile collision. A person with osteoporosis may sustain a pelvic fracture from a lower-impact injury such as a minor fall. Further, major parts of the bladder, bowel, reproductive organs, nerves, and blood vessels pass through the pelvic ring, and traumatic pelvic fractures that result from a high-impact event often coincide with damaged organs, significant bleeding, and sensory and motor dysfunction. Following are the steps in the rating process: 1) assign the diagnosis and impairment class for the pelvis; 2) assign the functional history, physical examination, and clinical studies grade modifiers; and 3) apply the net adjustment formula. Because pelvic fractures are so uncommon, raters may be less familiar with the rating process for these types of injuries. The diagnosis-based methodology for rating pelvic fractures is consistent with the process used to rate other musculoskeletal impairments. Evaluators must base the rating on reliable data when the patient is at maximum medical impairment and must assess possible impairment from concomitant injuries.

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