Severe Pelvic Fractures Research Articles

Functional and return to work outcomes following major trauma involving severe pelvic ring fracture.

There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture. Adult survivors to discharge from two major trauma centres with AO/Tile type B and C fractures were followed up at 6, 12 and 24-months post-injury to capture functional (Glasgow Outcome Scale-Extended [GOS-E]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome. A total of 111 of 114 (97%) cases were followed up. The mean (SD) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport-related and 90% were multi-trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently (GOS-E > 4) and 59% had returned to work. Higher Injury Severity Scores (ISS) were associated with lower risk-adjusted odds of return to work (P = 0.04) and independent living (P = 0.06). Post-operative infection was associated with living independently (P = 0.02). Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2-years post-injury. Fracture type and management were not key predictors of outcome. Large-scale multi-centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management.

Predicting the need for massive transfusion in trauma patients: the Traumatic Bleeding Severity Score.

The ability to easily predict the need for massive transfusion may improve the process of care, allowing early mobilization of resources. There are currently no clear criteria to activate massive transfusion in severely injured trauma patients. The aims of this study were to create a scoring system to predict the need for massive transfusion and then to validate this scoring system. We reviewed the records of 119 severely injured trauma patients and identified massive transfusion predictors using statistical methods. Each predictor was converted into a simple score based on the odds ratio in a multivariate logistic regression analysis. The Traumatic Bleeding Severity Score (TBSS) was defined as the sum of the component scores. The predictive value of the TBSS for massive transfusion was then validated, using data from 113 severely injured trauma patients. Receiver operating characteristic curve analysis was performed to compare the results of TBSS with the Trauma-Associated Severe Hemorrhage score and the Assessment of Blood Consumption score. In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p < 0.01). The area under the receiver operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively. The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility. Prognostic study, level III.

Open reduction and internal fixation for floating symphysis pubis

Objective To explore the clinical characteristics of the floating injury of symphysis pubis and clinical outcome of open reduction and internal fixation.Methods A retrospective study was conducted to analyze the 48 patients who had been treated in our department with open reduction and internal fixation for the floating injury of Symphysis pubis from January 2008 to January 2013.There were 31 males and 17 females,with an average age of 36.5 years (range,20 to 61 years).Thirty-five patients were injured in traffic accidents and 8 were injured by falling injuries,and the other 5 were crushed by maehine.Fortyfive cases were complicated with fractures of the posterior pelvis ring; 14 cases were complicated with acetabular fractures; 17 cases were complicated with extremity fractures; 1 1 cases were complicated with thoracic and abdominal injuries and 6 cases were associated with urogenital system injury.The average period from trauma to operation was 7 days (range,3 to 25 days).Operation was performed under general anesthesia.The bilateral pubic ramus fractures were fixed with reconstruction plate in 41 cases,and 7 cases were fixed with cannulated screw through minimally invasive method.Forty-one cases with posterior ring fractures were fixed simulaneously.Results There were 44 patients being followed up with an average period of 16 months (range,12 to 30 months).All the fractures of the pelvis were clinically healed with an average period of 12.6 weeks (range,10 to 16 weeks).According 图o the Majeed score system,the functional results were exc ellent in 30 cases,good in 10 cases,and fair in 4 cases; The average score was 81.5 (range,60 to 100).Two patients who had wound fat liquefaction at 3 days after operation were healed by dressing changing; 8 patients got deep vein thrombosis at 10 days (range,5 to 15 days) after operation were cured by conservative treatment; 3 patients got supra pubic pain at 6 days (range,5 to 7 days) after operation were healed by oral non steroidal anti-inflammatory analgesic drugs and physical therapy in one year.Conclusion Floating injury of symphysis pubis is a kind of severe pelvic fracture which affects the stability of pelvic ring.Open reduction and internal fixation is a good method to stabilize the pelvis ring and to get early rehabilitation.This may contribute to good clinical resuls and good function. Key words: Pelvis; Pubic symphysis; Fractures; Fracture fixation, internal

Damage control strategies in the management of acute injury.

Traumatic injury is the leading cause of death worldwide. The rapid evaluation and correction of injuries in these patients is paramount to preventing uncontrolled decompensation and death. Damage control strategies are a compendium of techniques refined over decades of surgical care that focus on the rapid correction of deranged physiology, control of contamination and blood loss, and resuscitation of critical patients. Damage control resuscitation (DCR) focuses on the replacement of lost blood volume in a manner mimicking whole blood, control of crystalloid administration, and permissive hypotension. Damage control laparotomy controls gastrointestinal contamination and bleeding in the operative suite, allowing rapid egress to the intensive care unit for ongoing resuscitation. Pelvic packing, an adjunct to DCR, provides a means to control hemorrhage from severe pelvic fractures. Temporary vascular shunts restore perfusion, while resuscitation and reconstruction are ongoing. Taken together, these strategies provide the trauma surgeon with a powerful arsenal to preserve life in the transition from injury to the shock trauma room to the intensive care unit.

Assessment of pelvic fractures resulting from the 2010 Haiti earthquake

On January 12, 2010, a catastrophic 7.0 magnitude earthquake shook the Haitian capital of Port-au-Prince. Because of their sudden and destructive nature, earthquakes can result in unfamiliar mass casualty situations accompanied by devastating orthopedic injuries. Evaluation of the pelvic fractures resulting from this earthquake revealed several factors that we hope will facilitate optimal preparation and planning for future disaster situations. A cohort of patients with earthquake-related pelvic ring fractures who were treated aboard the USNS Comfort was retrospectively analyzed. Anteroposterior radiographs of the pelvis were evaluated and categorized according to the Young-Burgess classification system. Sixty-eight patients were included in the cohort. The mean (SD) age was 29.6 (14.4) years. Nineteen patients (29.7%) were male, and 49 (70.3%) were female. Pelvic fractures were categorized as anteroposterior compression in 7 patients, lateral compression (LC) in 47 patients, vertical shear (VS) in 8 patients, and combination of pelvic ring/acetabulum in 6 patients. Among the 23 patients treated operatively, the mean (SD) delay from injury to surgery was 19.2 (7.4) days. Patients showed predominance toward LC injuries (69.1%), consistent with crush under rubble. Thirty-one percent of the fractures were considered unstable (anteroposterior compression Type III, LC Type III, VS, and combination of pelvic ring/acetabulum). The VS injuries observed (11.8%) may be the result of a previously unidentified injury mechanism, an upright individual being struck by falling rubble, violently applying a downward force to the body over an extended lower extremity. A substantial delay in the treatment observed in this series may lead to an underestimation of both quantity and severity of pelvic fractures as critically ill patients may have perished before evaluation and treatment. In addition, the application of pelvic sheeting techniques may be a lifesaving intervention for interval pelvic stabilization following earthquakes in which medical resources are scarce. Epidemiologic study, level III; therapeutic study, level V.

Laparotomy or Angiography First for Pelvic Fracture with Intraperitoneal Hemorrhage

Up to two thirds of patients with severe pelvic fracture also have intraperitoneal hemorrhage, and debate continues about which area of hemorrhage to stabilize first. In an observational cohort study, researchers used the Japan Trauma Data Bank to determine patient outcomes based on whether laparotomy or pelvic angiography was performed first. Of 317 trauma patients with pelvic fracture and positive results on Focused …

Quality of Life and Sexual Function After Traumatic Pelvic Fracture

To provide evidence on the midterm sexual-function- and health-related quality-of-life outcome of patients with a traumatic pelvic fracture, as recorded at least 12 months after their surgery. Prospective noncomparative study. Tertiary referral centre for pelvic-and-acetabular reconstruction. Cohort of patients attending a dedicated pelvic-and-acetabular reconstruction clinic because of blunt pelvic trauma, at a minimum of a year after their injury. Operatively treated pelvic fractures and concomitant surgical interventions for associated injuries, if any, sustained by the patients after blunt trauma. Sexual function questionnaires: IIEF (international index of erectile function) and FSFI (female sexual function index). Quality of life was assessed with the EuroQol-5D questionnaire. Of a cohort of 110 patients, 80 patients (48 males and 32 females) consented to participate with a median age of 46 years (range, 19-65 years). Of the above cohort, 62.5% were a result of road traffic accidents and 52.5% were classified as lateral compression type fractures. Assessment occurred at a median period of 36 months after injury (range, 12-96). Overall, significant decrease of their quality of life (P < 0.0001) and sexual function were recorded (males, P < 0.00014; females, P < 0.001). Sexual dysfunction was identified in 43.8% of the female and 52.1% of the male patients, as per the validated gender-specific sexual function scores (female sexual function index and international index of erectile function, respectively). Regression analysis identified the presence of urinary tract injury (P < 0.049) and open surgical treatment (P < 0.047) as independent risk factors for sexual dysfunction. A near significant association with injury severity score (P = 0.05) was seen. Male gender (P < 0.006), abdominal injury (P < 0.0001), pelvic fracture severity (P < 0.049), pain (P < 0.0001), and sexual dysfunction (P < 0.034) were identified as significant independent risk factors for decreased quality of life. All domains of female and male sexual function were significantly decreased at a minimum of a year after pelvic fracture. Quality of life was also significantly decreased in this group with sexual dysfunction shown to be an independent risk factor for decreased quality of life after injury. Further pivotal clinical studies should follow based on the provided evidence. High clinical suspicion and prompt engagement of appropriate multidisciplinary pathways, including urological, gynecological, and psychiatric consultations, is recommended. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Management of severe pelvic injury following road traffic accident in a resource-limited setting

A 34 year old woman involved in road traffic accident with severe anterior and posterior pelvic fractures with associated soft tissue injury was referred from Wa Regional Hospital 18 hours after the accident to Tania Specialist Hospital in Tamale. Emergency resuscitative measures such as catheterization and management of pain with analgesics were initiated. Computed topography (CT scan) or Magnetic resonance imaging has been recommended as the appropriate tools for risk assessment in such cases however none of this was available at the time of the accident. The only assessment tool available was the C-arm machine which was used to X-ray the pelvis in the follow-ing plane; anterio – posterior pelvic - inlet and pelvic – outlet. Early internal reduction and stabili-zation of pelvis was immediately carried out using the procedure of open reduction and internal fixation (ORIF). Approximately 2 weeks after the operation, radiographs showed signs of healing and the patient was discharged on partial body weight bearing. Upon second review 12 weeks post operatively, complete recovery was accomplished.Keywords: Anatomy, pelvic injury, motor accident, resource-limited setting, Ghana

The imaging and classification of severe pelvic ring fractures

We describe the routine imaging practices of Level 1 trauma centres for patients with severe pelvic ring fractures, and the interobserver reliability of the classification systems of these fractures using plain radiographs and three-dimensional (3D) CT reconstructions. Clinical and imaging data for 187 adult patients (139 men and 48 women, mean age 43 years (15 to 101)) with a severe pelvic ring fracture managed at two Level 1 trauma centres between July 2007 and June 2010 were extracted. Three experienced orthopaedic surgeons classified the plain radiographs and 3D CT reconstruction images of 100 patients using the Tile/AO and Young-Burgess systems. Reliability was compared using kappa statistics. A total of 115 patients (62%) had plain radiographs as well as two-dimensional (2D) CT and 3D CT reconstructions, 52 patients (28%) had plain films only, 12 (6.4%) had 2D and 3D CT reconstructions images only, and eight patients (4.3%) had no available images. The plain radiograph was limited to an anteroposterior pelvic view. Patients without imaging, or only plain films, were more severely injured. A total of 72 patients (39%) were imaged with a pelvic binder in situ. Interobserver reliability for the Tile/AO (Kappa 0.10 to 0.17) and Young-Burgess (Kappa 0.09 to 0.21) was low, and insufficient for clinical and research purposes. Severe pelvic ring fractures are difficult to classify due to their complexity, the increasing use of early treatment such as with pelvic binders, and the absence of imaging altogether in important patient sub-groups, such as those who die early of their injuries.

Early effectiveness of endoscopic posterior urethra primary alignment

Posterior urethra primary realignment (PUPR) after complete transection may decrease the gap between the ends of the transected urethra, tamponade the retropubic bleeding, and optimize urinary drainage without the need of suprapubic catheter facilitating concurrent pelvic orthopedic and trauma procedures. Historically, the distorted anatomy after pelvic trauma has been a major surgical challenge. The purpose of the study was to assess the relationship of the severity of the pelvic fracture to the success of endoscopic and immediate PUPR following complete posterior urethral disruption using the Young-Burgess classification system. A review of our Level I trauma center database for patients diagnosed with pelvic fracture and complete posterior urethral disruption from January 2005 to April 2012 was performed. Pelvic fracture severity was categorized according to the Young-Burgees classification system. Management consisted of suprapubic catheter insertion at diagnosis followed by early urethral realignment when the patient was clinically stable. Failure of realignment was defined as inability to achieve urethral continuity with Foley catheterization. Clinical follow-up consisted of radiologic, pressure studies and cystoscopic evaluation. A total of 481 patients with pelvic trauma from our trauma registry were screened initially, and 18 (3.7%) were diagnosed with a complete posterior urethral disruption. A total of 15 primary realignments (83.3%) were performed all within 5 days of trauma. The success rate of early realignment was 100%. There was no correlation between the type of pelvic ring fracture and the success of PUPR. Postoperatively, 8 patients (53.3%) developed urethral strictures, 3 patients (20.0%) developed incontinence, and 7 patients (46.7%) reported erectile dysfunction after the trauma. The mean follow-up of these patients was 31.8 months. Endoscopic PUPR may be an effective option for the treatment of complete posterior urethral disruption and enables urinary drainage to best suit the multispecialty surgical team. The success rate of achieving primary realignment did not appear to be related to the complexity and type of pelvic ring fracture.

Pelvic Fractures: Part 1. Evaluation, Classification, and Resuscitation

Pelvic fractures range in severity from low-energy, generally benign lateral compression injuries to life-threatening, unstable fracture patterns. Initial management of severe pelvic fractures should follow Advanced Trauma Life Support protocols. Initial reduction of pelvic blood loss can be provided by binders, sheets, or some form of external fixation, which serve to reduce pelvic volume, stabilize clot formation, and reduce ongoing tissue damage. Persistently unstable patients may benefit from angiography with selective embolization, pelvic packing, or a combination of these interventions. Open pelvic fractures involving the perineum or bowel injury benefit from fecal diversion by colostomy. Trauma team coordination facilitates efficient resuscitative efforts and may affect definitive management by optimizing incision, ostomy, or catheter placement. Established protocols for both open and closed pelvic fractures help to standardize care.

14 INDICATIONS AND CLINICAL OUTCOMES OF TAE IN PATIENTS WITH BLUNT DEEP RENAL INJURY

You have accessJournal of UrologyTrauma/Reconstruction: Traum & Reconstructive Surgery (1)1 Apr 201314 INDICATIONS AND CLINICAL OUTCOMES OF TAE IN PATIENTS WITH BLUNT DEEP RENAL INJURY Masato Yanagi, Go Kimura, Jun Akatsuka, Yukihiro Kondo, Yuki Endo, Taiji Nishimura, Kimiyoshi Mizunuma, Masatoku Arai, Hiroyuki Yokota, Ken Nakazawa, Satoru Murata, and Shinichiro Kumita Masato YanagiMasato Yanagi Tokyo, Japan More articles by this author , Go KimuraGo Kimura Tokyo, Japan More articles by this author , Jun AkatsukaJun Akatsuka Tokyo, Japan More articles by this author , Yukihiro KondoYukihiro Kondo Tokyo, Japan More articles by this author , Yuki EndoYuki Endo Tochigi, Japan More articles by this author , Taiji NishimuraTaiji Nishimura Tochigi, Japan More articles by this author , Kimiyoshi MizunumaKimiyoshi Mizunuma Tochigi, Japan More articles by this author , Masatoku AraiMasatoku Arai Tokyo, Japan More articles by this author , Hiroyuki YokotaHiroyuki Yokota Tokyo, Japan More articles by this author , Ken NakazawaKen Nakazawa Tokyo, Japan More articles by this author , Satoru MurataSatoru Murata Tokyo, Japan More articles by this author , and Shinichiro KumitaShinichiro Kumita Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1388AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We retrospectively investigated the cases of the blunt deep renal injury and evaluated usefulness of transcatheter arterial embolization (TAE). METHODS We reviewed the records of patients with blunt deep renal injury who were treated in the critical care center of Nippon Medical School (NMS) Hospital and Ohtawara Red Cross (ORC) Hospital. The treatment modes and their outcomes were investigated. RESULTS We found 26 cases of blunt deep renal injury. 14 in NMS from 2001 to 2011 and 12 in ORC from 2001 to 2009. Average age of patients was 45 (17-87). Six were women and 20 were men. As for the treatment modes, bed rest was 3 cases, TAE in 16 and laparotomy in 4. And 3 patients were nearly dead on arrival. Ten of 26 patients died, but not solely due to the renal injury. Seven of the 10 patients were in shock at arrival and did not respond to fluid resuscitation. Of these 7 patients, three patients were treated with TAE for renal injury, but they died of life-threating concomitant injury: two severe head injury, and one severe pelvic fracture and severe spinal cord injury. On the other hand, 16 of 26 patients survived. Twelve patients who were in shock or pre-shock and responded to fluid resuscitation, were treated successfully with TAE. Three patients without severe anemia, severe hemorrhage, and severe concomitant injury were treated successfully with only bed rest. One patient was treated with nephrectomy because the kidney bleeding developed into hemoperitoneum. CONCLUSIONS TAE instead of nephrectomy is useful for the patients with blunt deep renal injury who respond to fluid resuscitation. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e6 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masato Yanagi Tokyo, Japan More articles by this author Go Kimura Tokyo, Japan More articles by this author Jun Akatsuka Tokyo, Japan More articles by this author Yukihiro Kondo Tokyo, Japan More articles by this author Yuki Endo Tochigi, Japan More articles by this author Taiji Nishimura Tochigi, Japan More articles by this author Kimiyoshi Mizunuma Tochigi, Japan More articles by this author Masatoku Arai Tokyo, Japan More articles by this author Hiroyuki Yokota Tokyo, Japan More articles by this author Ken Nakazawa Tokyo, Japan More articles by this author Satoru Murata Tokyo, Japan More articles by this author Shinichiro Kumita Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

11 SUCCESS RATE OF EARLY PRIMARY URETHRAL REALIGNMENT IS INDEPENDENT OF THE SEVERITY OF PELVIC TRAUMA AFTER TOTAL POSTERIOR URETHRAL DISRUPTION

INTRODUCTION AND OBJECTIVES: Recent studies have shown a role for early urethral primary realignment after complex pelvic trauma. Technical difficulties may be overcome with appropriate technique and technology. We examined the success rate of early urethral primary realignment of total posterior urethral disruption after complex pelvic trauma and the correlation of the severity of pelvic fracture. METHODS: An analysis of a prospective database was performed of patients with pelvic fracture associated with total urethral disruption underwent urethral realignment from 2005 to 2012 at Level I Trauma Center. Fractures were classified according to the orthopedic Young-Burgess classification. Initial urological management consisted of suprapubic tube insertion when the patient was unable to void. We utilized anterograde flexible cystoscopy via suprapubic tube, retrograde rigid cystoscopy and real-time fluoroscopy. Failure of realignment was defined as the inability of urethral catheterization using a retrograde/ anterograde approach. Follow up consisted of urethrograms, urofluxometry and cystoscopy evaluation. We also analyzed continence and erectile function after trauma. The necessity of other procedures such as dilatation, DVIU or urethroplasty was also evaluated after catheter removal. RESULTS: A total of 480 consecutive patients were screened and we found 18 patients with total posterior urethral disruption after complex pelvic trauma with the inability to void. The mean patient age was 40 years. The success rate of the procedure was 100%. Mean operating time was 47 11 minutes. Estimated blood loss was minimal. A total of patients 50.0% had associated organ related injuries. The realignment was accomplished within 3 days after admission. There was no correlation between the orthopedic type of classification and the success of urethral realignment. A total of 10 (56%) patients developed urethral strictures during follow up. Urinary incontinence occurred in 3 (17%) patients and 10 (56%) patients self-reported erectile dysfunction after the trauma. The mean follow up of these patients were 30.2 months. CONCLUSIONS: Early primary endoscopic realignment of total posterior urethral disruption after complex pelvic trauma had 100% success rate due to technology and surgical technique. Moreover, there was no correlation of the severity of pelvic fracture. Pelvic orthopedic classification did not show correlation with post procedure urinary incontinence or erectile function after the trauma.

Transcatheter embolotherapy after external surgical stabilization is a valuable treatment algorithm for patients with persistent haemorrhage from unstable pelvic fractures: Outcomes of a single centre experience

PurposeThe management of hemodynamically unstable patients with severe pelvic fractures remains a challenge. Various treatment strategies have been advocated. This study analyzed the value of transcatheter angiographic embolization (TAE) for persistent haemodynamic instability after initial fracture stabilization. Materials and methodsFrom January 2002 to July 2011, 803 patients were identified with pelvic fractures, 295 of them (37%) were presenting with unstable pelvic fractures. Fifteen patients, all with unstable fractures (2%), remained hypotensive (systolic blood pressure<90mmHg) despite adequate fluid resuscitation and emergent surgical fracture stabilization, subsequently underwent TAE. ResultsThe median age in the TAE-group was 57.9 years±20.12 (min 22; max 82) and the median ISS (injury severity score) was 35.8±11.7 (min 22; max 66). 13 out of 15 patients (87%) received initial external fixation and 2 patients (13%) where treated with a C-Clamp before TAE. Radiological success, defined as absence of contrast extravasation on completion angiography, was observed in all 15 patients. In total 3 (20%) patients died during the period of hospitalization, none of them owing to persistent or recurrent pelvic haemorrhage. In the remaining 12 patients, no early or late complications of TAE were identified. Preperitoneal pelvic packing was performed in two patients, both had open pelvic fractures. ConclusionTAE is a safe and very efficient procedure to treat persistent haemorrhage in patients with unstable pelvic fractures initially treated by surgical fracture stabilization procedures. On the long term, no early or late bleeding recurrence could be demonstrated with an overall survival rate of 80%. Preperitoneal pelvic packing can be reserved for patients with open fractures and active bleeding.

Identifying Occult Arterial Bleeding by a Relaxing (Loosening) Pelvic Stabilization Device in Severe Pelvic Fracture

Identifying Occult Arterial Bleeding by a Relaxing (Loosening) Pelvic Stabilization Device in Severe Pelvic Fracture

Evaluation of the relationship between pelvic fracture and abdominal compartment syndrome in traumatic patients

Introduction:An increase in abdominal pressure can lead to so-called intra–abdominal compartment syndrome (ACS). Multiple factors such as an increase in retroperitoneal volume due to pancreatitis, bleeding and edema as a result of pelvic fracture can lead to compartment syndrome. Prevention is better than cure in compartment syndrome. By measuring the intra-abdominal pressure (IAP) through the bladder, a quick and accurate assessment of abdominal pressure is achieved. Therefore, this study aimed to evaluate the relationship between pelvic fracture and ACS in traumatic patients.Materials and Methods:This research was a descriptive–analytical study conducted on 100 patients referring to the Shiraz Nemazee Hospital in 2010. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder using the procedure described by Kron et al. Data collected were analyzed using SPSS software.Results:The findings showed that ACS occurred in 28 of 100 patients. With regard to the associated injuries with abdominal trauma, 19% of all patients and 46/42% of the patients with ACS had pelvic fracture. Chi-square test revealed a significant relationship between pelvic fracture and incidence rate of ACS (P < 0.001).Conclusions:According to the collected data, pelvic fracture due to a trauma can be one of the important causes of an increase in IAP and ACS. In this lethal condition, prevention is better than cure. Therefore, serial measurement of IAP through the bladder in high-risk patients (those with pelvic fracture by trauma) is recommended to the nurses to diagnose this condition and to decrease the incidence of mortality.

Abstract 336: The Novel and Useful Scoring System to Predit Massive Transfusion for Trauma Patients: Traumatic Bleeding Severity Score (TBSS)

Background: There is no clear criterion to activate massive transfusion (MT) for trauma patients. Several studies showed that Trauma Associated Severe Hemorrhage (TASH) score and Assessment of Blood Consumption (ABC) Score were high accuracy in predicting the necessity of MT for trauma patients. However, some study showed that the accuracy of these scoring systems for elderly patients was not perfect. In japan, since the population is aging and the number of elderly trauma patient increases, these scoring systems are not useful so much. The aim of this study was to create new scoring system and predict the necessity of MT for trauma patients using it. Methods: In the first analysis, new scoring system was created. We enrolled 119 severe trauma patients admitted to our center between January 2008 and December 2010. MT predictors were found by statistical methods from clinical and laboratory variables in the Primary Survey. Each MT predictor was converted into the simple score based on each odds ratio in multivariate logistic regression analysis. TBSS was defined as the total of each score. In the second analysis, the accuracy of TBSS was tested. 114 patients admitted between January 2010 and March 2012 were examined. Receiver operating characteristic curve analysis were performed to compare the accuracy between TBSS and conventional scoring systems (TASH Score and ABC Score). Results: In the first analysis, five preditors of MT were identified: age (&gt; 60 year-old = 6pts), systolic blood pressure (&lt; 110 mmHg = 4pts, &lt; 100 mmHg = 8pts, &lt; 90 mmHg = 12pts), positive focused assessment with sonography for trauma (FAST) ( [the number of regions with positive FAST] × 3pts), severity of pelvic fracture (stable fracture = 3pts, incomplete unstable fracture = 6pts, complete unstable fracture = 9pts), and lactate (&gt; 2.5 mmol/L = 4pts, &gt; 5.0 mmol/L = 8pts, &gt; 7.5 mmol/L = 12pts). In the second analysis, TBSS excellently predicted MT (area under the curve (AUC) =0.985, p&lt;0.01). The AUC of TBSS was higher than that of TASH Score (AUC=0.887) and ABC Score (AUC=0.809) (both Bonferoni adjusted p&lt;0.05). Conclusion: TBSS based on the Primary Survey is high accuracy in predicting the necessity of MT. TBSS provide more useful information to predict MT compared with TASH Score and ABC Score.

Multidisciplinary Management of Blunt Pelvic Trauma

Pelvic fractures account for ∼3% of all fractures and usually occur in patients with polytrauma. Pelvic fractures usually indicate high energy transfer and a significant mechanism of injury, and they can involve massive hemorrhage. For this reason, mortality from pelvic trauma is high, ranging from 40% to 60% among patients in shock, and up to 90% in patients considered to be in extremis. Multidisciplinary approaches in the treatment of patients with pelvic fractures have resulted in improved outcomes for these complex and challenging injuries. In this article, we describe a case of a pediatric patient who suffered severe pelvic fracture with massive hemorrhage, requiring a multidisciplinary approach for control of hemorrhage and definitive repair of injuries.

Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications

BackgroundUndertriage of elderly trauma patients to tertiary trauma centers is well documented. This study evaluated the impact of directness of transport to a Level I trauma center on morbidity in geriatric trauma patients sustaining severe pelvic fractures. MethodsThis was a retrospective cohort study of 87 geriatric trauma patients diagnosed with potentially unstable pelvic fractures, treated at a Level I trauma center between 2008 and 2010. ResultsOf the 87 patients, 39% (34 of 87) initially were transported to a nontertiary trauma center. After adjusting for presence of comorbidity and injury severity, the 2-week incidence of complications was 54% higher in transferred patients compared with those directly transported (rate ratio, 1.54; 95% confidence interval, .95–2.54). In particular, transferred patients had increased odds of developing pneumonia/systemic inflammatory response syndrome. ConclusionsDespite lacking precision, results of this study suggest an increased risk of complications in transferred geriatric trauma patients with severe pelvic fractures compared with their directly transported counterparts.

Application of damage control surgery in treatment of severe pelvic fracture combined with abdominal organ injuries

Objective To probe into the feasibility and efficacy of damage control surgery (DCS) in treating severe pelvic fracture combined with abdominal organ injuries.Methods A retrospective analysis was done on the clinical data of 39 patients with severe pelvic fractures combined with abdominal organ injuries treated by DCS from 1995 to 2010.Results Devascularization of internal iliac arteries was performed to treat massive hemorrhage in the 39 patients with severe pelvic fractures combined with abdominal organ injuries,including ligation of bilateral internal iliac arteries in 31 palients and angioembolization of bilateral internal iliac arteries in eight.Meanwhile,early pelvic external fixators were used in 31 patients.All patients received discriminating internal fixation after resuscitation in ICU.The overall mortality rate was 21％ (8/39),with average ISS of 41.6 points and with hemorrhagic shock and combined injury for the main causes of death.Complications occurred in seven patients including combined acute respiratory distress syndrome (ARDS) in three patients,thrombosis of right common iliac artery in one,subphernic abscesses in two,and deep infection of lower extremity in one,but all the complications were cured.Conclusions Reasonable and timely use of DCS can enhance the rescue survival rate of patients with severe pelvic fraclure combined with abdominal organ injuries. Key words: Multiple trauma; Pelvis; Abdominal injuries; Fracture fixation; Damagecontrol surgery