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Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091291. [PMID: 36143972 PMCID: PMC9503952 DOI: 10.3390/medicina58091291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective hemodynamic stabilization after C-clamp application by means of vital parameters (primary outcome parameter), and the subsequent effect on metabolic indices and volume management (secondary outcome parameters). Materials and Methods: C-clamp application was performed between 2014 and 2021 for n = 13 patients (50 ± 18 years) with unstable pelvic fractures and hemodynamic instability. Vital parameters, metabolic indices, volume management, and the correlation of factors and potential changes were analyzed. Results: After C-clamp application, increases were measured in systolic blood pressure (+15 mmHg; p = 0.0284) and mean arterial pressure (+12 mmHg; p = 0.0157), and a reduction of volume requirements (p = 0.0266) and bolus vasoactive medication needs (p = 0.0081) were observed. The earlier C-clamp application was performed, the greater the effect (p < 0.05; r > 0.6). Heart rate, shock index, and end-tidal CO2 were not significantly altered. The extent of base deficit, hemoglobin, and lactate did not correlate with changes in vital parameters. Conclusions: In the majority of hemodynamically unstable trauma patients not responding to initial fluid resuscitation and severe pelvic fracture, early C-clamp application had an additive effect on hemodynamic stabilization and reduction in volume substitution. Based on these findings, there is still a rationale for considering early C-clamp stabilization in this group of severely injured patients.
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Lai CY, Lai PJ, Tseng IC, Su CY, Hsu YH, Chou YC, Yu YH. Postoperative Reduction Quality May Be the Most Important Factor That Causes Worse Functional Outcomes in Open and Closed Pelvic Fractures. World J Surg 2022; 46:568-576. [PMID: 34973073 PMCID: PMC8803804 DOI: 10.1007/s00268-021-06386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.
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Affiliation(s)
- Chih-Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Po-Ju Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - I-Chuan Tseng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan Branch, Tao-Yuan City, Taiwan
| | - Chun-Yi Su
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Kee-Lung City, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan.
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Guo Q, Zhang L, Zhou S, Zhang Z, Liu H, Zhang L, Talmy T, Li Y. Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases. J Orthop Surg (Hong Kong) 2021; 28:2309499020939830. [PMID: 32696709 DOI: 10.1177/2309499020939830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study aimed to investigate the clinical features, current management strategies, and outcomes of open pelvic fracture patients. METHODS We performed a retrospective review of data on patients with blunt trauma and open pelvic fractures admitted to our trauma center over a 5-year period (January 2013 to December 2017). Demographic as well as clinical data including injury mechanism, injury severity score (ISS), fracture classifications, transfusion requirements, interventions, length of hospital and intensive care unit (ICU) stay, and prognosis were investigated. Univariate analysis and binary logistic regression were used to identify the risk variables of death. Finally, a brief literature review was performed to understand the current capacity of treatment and prognosis of this type of injury. RESULTS Forty-six patients (36 male and 10 female) were included in this study, mean age 43.2 ± 14.2 years. The overall mortality rate was 17.4%; 43.5% of the patients were hypotensive (systolic blood pressure (SBP) <90 mmHg) on arrival. The average ISS was 31.7 ± 6.7, and the average packed red blood cell (PRBC) transfusion during the first 24 h was 9.6 ± 7.4 units. Five patients (10.9%) underwent transcatheter arterial embolization in the early stage of management. The average hospital and ICU length of stay were 53.0 ± 37.6 days and 14.3 ± 15.3 days, respectively. Statistically significant differences were found in ISS, PRBC units received with the first 24 h, SBP, lactate and base excess on admission, and mechanism of injury when comparing between the death and the survival groups (p < 0.05). ISS and lactate on admission were found to be the independent risk factors for mortality. CONCLUSION The mortality rate of open pelvic fractures remains high. ISS and lactate on admission were the independent risk factors for mortality. Optimization of the trauma care algorithms for early identification and treatment of this injury could be the key to decreasing mortality.
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Affiliation(s)
- Qingshan Guo
- State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Trauma and War injury, Daping Hospital, Army Medical University, Chongqing, China.,* Qingshan Guo and Letian Zhang Contributed equally to this work
| | - Letian Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China.,* Qingshan Guo and Letian Zhang Contributed equally to this work
| | - Siru Zhou
- State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Trauma and War injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhiyang Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Trauma and War injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Huayu Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Trauma and War injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Lianyang Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Trauma and War injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Tomer Talmy
- The Institute of Research in Military Medicine, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yang Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Trauma and War injury, Daping Hospital, Army Medical University, Chongqing, China
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Song W, Zhou D, Xu W, Zhang G, Wang C, Qiu D, Dong J. Factors of Pelvic Infection and Death in Patients with Open Pelvic Fractures and Rectal Injuries. Surg Infect (Larchmt) 2017; 18:711-715. [PMID: 28759327 DOI: 10.1089/sur.2017.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries. METHODS We retrospectively reviewed the records of patients with open pelvic fractures and rectal injuries who were treated at our institution from January 2010-April 2014. From the medical records, age, gender, Injury Severity Score (ISS), cause of fracture, associated injuries, classification of the fracture, degree of soft-tissue injury, Glasgow Coma Score (GCS), Revised Trauma Score (RTS), packed red blood cells (PRBCs) needed, presence/absence of shock, early colostomy (yes or no), drainage (yes or no), and rectal washout (yes or no) were extracted. Univariable and multivariable analysis were performed to determine the association between risk factors and pelvic infection or death. RESULTS Twenty patients were identified. Pelvic infection occurred in 50% (n = 10) of the patients. Four patients suffered septicemia, and three patients died of multiple organ dysfunction. The mortality rate thus was 15%. According to the univariable analysis, the patients in whom pelvic infection developed had shock, RTS ≤8, GCS ≤8, blood transfusion ≥10 units in the first 24 h, no colostomy, or Gustilo grade III soft-tissue injury. According to the multivariable analysis, shock and absence of colostomy were independently associated with pelvic infection. By univariable analysis, the only factor associated with death was RTS ≤8. CONCLUSION The incidence of pelvic infection was lower in patients having early colostomy (p < 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and concurrent rectal injury. Open reduction and internal fixation after extensive debridement is recommended in patients with unstable pelvic fractures.
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Affiliation(s)
- Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Weicheng Xu
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Guoming Zhang
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Chunhui Wang
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Daodi Qiu
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
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