Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2012; 79(3):193-202 | DOI: 10.55095/achot2012/029

Management of Hemodynamic Unstable Patients "in extremis" with Pelvic Ring FracturesCurrent concepts review

A. GÄNSSLEN^1,*, F. HILDEBRAND², T. POHLEMANN³

¹ Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany

² Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany

³ Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany

The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk.
Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure ≤70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission.
The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%.
Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts.
Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources.
In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.

Published: June 1, 2012  Show citation