Abstract
Pelvic ring injuries (PRI) are among the most difficult injuries to deal with in orthopedic trauma. When these injuries are accompanied by hemodynamic instability their management becomes significantly more complex. A methodical assessment and expeditious triage are required for these patients followed by adequate resuscitation. A major triage decision is whether these patients should undergo arterial embolization in the angiography suit or prompt packing and pelvic stabilization in the operating room. Patient characteristics, fracture type and injury characteristics are taken into consideration in the decision-making process. In this review we discuss the acute evaluation, triage and management of PRIs associated with hemodynamic instability. An evidence based and protocol driven approach is necessary in order to achieve optimal outcomes in these patients.
Highlights
Pelvic ring injuries (PRIs) with hemodynamic instability typically occur in polytrauma patients
Their cohort included 178 patients admitted in shock, of which 18.5% were initially treated with pelvic binder, 24.7% went for diagnostic angiography (68.2% of whom were embolized), 9.6% were treated in an external fixator alone, 5.1% underwent preperitoneal packing alone, 5.1% underwent external fixator plus embolization, 1.7% external fixator plus pre-peritoneal packing, and 68% no pelvic intervention
The first published report of pelvic angiography in the setting of pelvic fractures was in a 1971 editorial by Athanasoulis et al [76] from Boston City Hospital, commenting on the possible utility of initial venography and subsequent arteriography as a diagnostic tool to identify the location of bleeding in the pelvis
Summary
El Naga 1, Jordan Barker 1, Jacob Matz 1, Styliani Stergiadou 2 and Theodore Miclau 1. Reviewed by: Feza Korkusuz, Hacettepe University, Turkey Seth Michael Tarrant, Hunter New England Health, Australia. Specialty section: This article was submitted to Orthopedic Surgery, a section of the journal
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