Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: early experience in a Korean trauma center

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Keum Seok Bae¹  Seongyup Kim¹  Pil Young Jung¹  Hongjin Shim¹  Ji Young Jang¹ 

[1] Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 220-701 Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea

关键词: Damage control;    Extraperitoneal pelvic packing;    Preperitoneal pelvic packing;    Hemorrhage;    Pelvis;   

Others  :  1235376
DOI  :  10.1186/s13049-016-0196-5

 received in 2015-09-07, accepted in 2016-01-06,  发布年份 2016

【 摘 要 】

Background

The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is reported to be 40–60 % despite a multidisciplinary treatment approach. Angioembolization and external fixation of the pelvis are the main procedures used to control bleeding in these patients. Several studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control, despite being small and observational in nature. The purpose of this study was to describe a Korean trauma center’s early experience with PPP in unstable patients with pelvic fractures and to evaluate its effectiveness.

Methods

Between January 2012 and May 2015, 30 patients with hemodynamic instability caused by pelvic fracture were enrolled in this study. PPP has been performed in 14 patients since May 2014. Data of pelvic fracture patients with hemodynamic instability were selected from Wonju Severance Christian Hospital Pelvic Trauma Database and were analyzed retrospectively.

Results

Mean age and mean ISS were 60.4 ± 18.8 years and 39.2 ± 8.1 in 30 unstable patients with pelvic fracture. Mean SBP was 89.1 ± 24.7 mmHg, and mean hemoglobin was 10.6 ± 2.3 g/dL. When the non-PPP group (16 patients) and the PPP group (14 patients) were compared, there was no significant difference in the age, gender, ISS, and occurrence of associated injury (p = 0.82, p = 0.23, p = 0.92, and p = 0.60, respectively). Mortality rate due to acute hemorrhage were 37.5 % in the non-PPP group and 14.3 % in the PPP group. In the PPP group, three patients underwent PPP in the hybrid operating room, and a laparotomy was performed in three patients. Mean systolic blood pressure increased significantly after PPP (71.6 ± 9.8 vs. 132.2 ± 36.4 mmHg, p = 0.002).

Conclusions

In unstable patients with pelvic fractures, PPP can be used as an effective treatment, complementary to AE, to control pelvic bleeding.

【 授权许可】

   
2016 Jang et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Sathy AK, Starr AJ, Smith WR, Elliott A, Agudelo J, Reinert CM et al.. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surgery Am Vol. 2009; 91:2803-10.
• [2]Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004; 35:671-7.
• [3]Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN et al.. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma. 2002; 16:553-61.
• [4]Eastridge BJ, Starr A, Minei JP, O’Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002; 53:446-50.
• [5]Mucha P, Welch TJ. Hemorrhage in major pelvic fractures. Surg Clin North Am. 1988; 68:757-73.
• [6]O’Neill PA, Riina J, Sclafani S, Tornetta P. Angiographic findings in pelvic fractures. Clin Orthop Relat Res. 1996; 329:60-67.
• [7]Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J et al.. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture--update and systematic review. J Trauma. 2011; 71:1850-68.
• [8]Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery. 1973; 73:454-62.
• [9]Conolly WB, Hedberg EA. Observations on fractures of the pelvis. J Trauma. 1969; 9:104-11.
• [10]Totterman A, Madsen JE, Skaga NO, Roise O. Extraperitoneal pelvic packing: a salvage procedure to control massive traumatic pelvic hemorrhage. J Traum Injury, Infec, Crit Care. 2007; 62:843-52.
• [11]Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Traum Injury, Infec, Crit Care. 2007; 62:834-9.
• [12]Tai DKC, Li WH, Lee KY, Cheng MN, Lee KB, Tang LF et al.. Retroperitoneal pelvic packing in the management of hemodynamically unstable pelvic fractures: a level I trauma center experience. J Traum Injury, Infec, Crit Care. 2011; 71:E79-86.
• [13]Burlew CC, Moore EE, Smith WR, Johnson JL, Biffl WL, Barnett CC et al.. Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J Am Coll Surg. 2011; 212:628-35.
• [14]Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AE et al.. Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury. 2009; 40:54-60.
• [15]Boffard KD. Manual of Definitive Surgical Trauma Care. 3rd ed. UK, Hodder Arnold; 2011. 3 p
• [16]D’Amours SK, Rastogi P, Ball CG. Utility of simultaneous interventional radiology and operative surgery in a dedicated suite for seriously injured patients. Curr Opin Crit Care. 2013; 19:587-93.
• [17]Kirkpatrick AW, Vis C, Dube M, Biesbroek S, Ball CG, Laberge J et al.. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations). Injury. 2014; 45:1413-21.
• [18]Byun CS, Park IH, Oh JH, Bae KS, Lee KH, Lee E. Epidemiology of trauma patients and analysis of 268 mortality cases: trends of a single center in Korea. Yonsei Med J. 2015; 56:220-6.
• [19]Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T et al.. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg. 2001; 233:843-50.