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Elamin MH, Elkaramany I, Salman LA, Albasha A, Parambathkandi A, Elramadi A, Ahmed G. The epidemiology of pelvic ring fractures in Qatar. INTERNATIONAL ORTHOPAEDICS 2024; 48:1097-1103. [PMID: 38296877 PMCID: PMC10933172 DOI: 10.1007/s00264-024-06103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE This study aimed to determine the incidence of pelvic ring fractures and their associated epidemiological profile in Qatar. METHODS A retrospective cross-sectional study was performed at the only level I trauma centre in Qatar for patients diagnosed with pelvic ring fractures between January 2016 and December 2018. Age, sex, mechanism of injury, fracture classification and associated characteristics, mode of treatment, associated nerve injuries, and other complications were analyzed. RESULTS A total of 327 consecutive patients were included, with an average age of 32.6 years. Most of the included patients were males, 85% (279), with a male: female ratio of 6:1. The incidence of pelvic fractures was 3.887/100,000 across the three years. High-speed motor vehicle collisions (MVC) were the most common mechanism of injury (108, 33%), followed by falling from height (105, 32%). Young-Burgess lateral compression (LC) fracture type was the most frequent (224, 68.5%) and was associated with 25% of the entire mortalities. Nine (2.8%) cases were open fractures, and 12% (39) were deemed unstable. Around 29% of cases had associated injuries, with an overall mortality rate of 4.9% (16) observed. Most fractures were treated nonoperatively(n = 283,86.5%). CONCLUSION This study demonstrated the epidemiology of pelvic fractures in Qatar. MVC and work-related injuries were predominant in a younger cohort compared to the literature. Also, the mortality rate was lower than those reported in the literature. Therefore, well-trained surgeons and specialized trauma centres for treating these injuries are recommended.
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Affiliation(s)
- Mohamed H Elamin
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Islam Elkaramany
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Loay A Salman
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Anas Albasha
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ashik Parambathkandi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ahmed Elramadi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Burton KR, Magidson PD. Trauma (Excluding Falls) in the Older Adult. Clin Geriatr Med 2023; 39:519-533. [PMID: 37798063 DOI: 10.1016/j.cger.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Trauma in the older adult will increasingly become important to emergency physicians hoping to optimize their patient care. The geriatric patient population possesses higher rates of comorbidities that increase their risk for trauma and make their care more challenging. By considering the nuances that accompany the critical stabilization and injury-specific management of geriatric trauma patients, emergency physicians can decrease the prevalence of adverse outcomes.
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Affiliation(s)
- Kyle R Burton
- Department of Emergency Medicine, Johns Hopkins Hospital, 1830 Eas, Monument Street, Suite 6-110, Baltimore, MD 21287, USA
| | - Phillip D Magidson
- Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Suite A150, Baltimore, MD 21224, USA.
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Desta T, Lodamo T, Mulat H, Demissie DB, Ayalew K. Prevalence and associated factors of infection after intramedullary nailing of long bone fractures among patients attending St. Paul's Hospital Millennium Medical College, AaBET Hospital, Addis Ababa, Ethiopia. SAGE Open Med 2023; 11:20503121231181648. [PMID: 37342615 PMCID: PMC10278399 DOI: 10.1177/20503121231181648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/26/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives The intramedullary nailing of long bone fractures is a major challenge for orthopedic surgeons, with increased risk of infection in third-world countries. Research gaps remain in Ethiopia, determining the magnitude of the problem. This study aimed to determine the prevalence and associated factors of infection after intramedullary nailing of long bone fractures in Ethiopia. Methods This was a descriptive, cross-sectional, retrospective design study with a total census of 227 cases of long bone fractures treated with intramedullary Surgical Implant Generation Network nails at Addis Ababa Burn Emergency and Trauma Hospital from August 2015 to April 2017. Data were collected from 227 patients and descriptive analyses were done to summarize the study variables. Binary and multivariable logistic regression analyses were performed at a p value of 0.05 with a 95% confidence interval and adjusted odds ratio. Results The mean age of patients was 32.9 years, with a male-to-female ratio of 3.5:1. Only 22 (9.3%) of the 227 patients with long bone fractures treated with intramedullary nails developed a surgical site infection, and 8 (3.4%) were developed deep (implant) infections requiring debridement. Road traffic injuries were the leading cause of trauma (60.9%), followed by falls from a height (22.7%). Debridement was done within 24 h for 52 (61.9%) and within 72 h for 69 (82.1%) patients with open fractures. Only 19 (22.4%) and 55 (64.7%) patients with open fractures and tibial long bone fractures received antibiotics within 3 h. Open fractures and tibial fractures had higher percentages of infection, 18.6% and 12.1%, respectively. Previous use of an external fixator (44.4%) and prolonged surgery (12.5%) were associated with higher proportions of infection. Conclusion This study found that the prevalence of infections after intramedullary nailing of long bone fractures in Ethiopia was 44.4% after external fixation, compared to 6.4% after intramedullary nail was inserted directly. Proper control measures are needed to reduce morbidity and complications related to long fracture treatment, such as open fractures, tibial fractures, the use of an external fixator, delayed debridement and skin closure, and prolonged surgery developed surgical site infection rate.
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Affiliation(s)
- Tilahun Desta
- Consultant Orthopaedic Surgeon, St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Teshale Lodamo
- Consultant Orthopaedic Surgeon, Sodo University Hospital, Sodo, Wolayita, Ethiopia
| | - Habtewold Mulat
- Consultant Orthopaedic Surgeon, St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | | | - Kalkidan Ayalew
- Consultant Orthopaedic Surgeon, St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
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Hörer TM, Ierardi AM, Carriero S, Lanza C, Carrafiello G, McGreevy DT. Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes. Semin Vasc Surg 2023; 36:283-299. [PMID: 37330241 DOI: 10.1053/j.semvascsurg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/19/2023]
Abstract
Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden; Department of Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden; Carmel Lady Davis Hospital, Technion Medical Faculty, Haifa, Israel.
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Carriero
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - David T McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden
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Parker W, Despain RW, Bailey J, Elster E, Rodriguez CJ, Bradley M. Military experience in the management of pelvic fractures from OIF/OEF. BMJ Mil Health 2023; 169:108-111. [PMID: 32938710 DOI: 10.1136/bmjmilitary-2020-001469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures. METHODS We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined. RESULTS Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy. CONCLUSIONS Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.
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Affiliation(s)
- William Parker
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - R W Despain
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - J Bailey
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - E Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - C J Rodriguez
- Division of Trauma, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - M Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Timmer RA, Mostert CQB, Krijnen P, Meylaerts SAG, Schipper IB. The relation between surgical approaches for pelvic ring and acetabular fractures and postoperative complications: a systematic review. Eur J Trauma Emerg Surg 2022; 49:709-722. [PMID: 36434301 PMCID: PMC10175345 DOI: 10.1007/s00068-022-02118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
Abstract
Introduction
Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is lacking. The current review provides a comprehensive summary of the complications after pelvic ring and acetabular fracture surgery in relation to the surgical approach.
Material and Methods
Pubmed and Embase databases were systematically searched using the key words: pelvic fracture, acetabular fracture, fixation, surgical approaches, complications, and their synonyms. Extracted data included patient and fracture characteristics, surgical approaches, and post-operative complications; surgical site infections (SSI), implant-related complications, malunion and non-union. Study data were summarized using descriptive statistics.
Results
Twenty-two studies (twenty-one retrospective cohort studies, of which three comparative, and one randomized controlled trial) were included in this review. The overall complication rates reported for the included surgical approaches were: 17% for the (Modified) Stoppa approach, 11% for percutaneous fixation, 5% for the Kocher–Langenbeck approach, 7% for the ilioinguinal approach and 31% for external fixation. The most frequent complications were SSI (22%) and neurological (31%) complications, which were most often reported in patients treated with an external fixator. Re-operation rates were comparable for the surgical approaches (4–8%). Two studies reported on risk factors and identified concomitant traumatic injuries, prolonged ICU stay and high body mass index as risk factors for SSI.
Conclusion
External fixation of pelvic fractures is associated with highest complications rates including SSI’s and neurological complications. Although post-operative complications are frequently reported after pelvic fracture surgery, more studies are needed that identify potential risk factors. These will assist the surgeon in (pre)operative decision making and development of preventive strategies.
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Park CH, Lee JW, Kim BS, Cho MR, Song SK. Prolonged ileus in traumatic pelvic ring injury patients who underwent arterial angio-embolization: A retrospective study. Medicine (Baltimore) 2022; 101:e30684. [PMID: 36181072 PMCID: PMC9524902 DOI: 10.1097/md.0000000000030684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Paralytic ileus occurs in up to 18% of the patients with pelvic bone fractures. The aim of this study is to determine if massive bleeding requiring arterial angio-embolization is related with the duration of ileus in patients with traumatic pelvic ring injuries. This retrospective study included 25 patients who underwent arterial angio-embolization for traumatic pelvic ring injuries. Data were collected from prospectively maintained databases of two independent hospitals. Demographic characteristics (such as age, sex, body mass index, and Charlson Comorbidity Index), cause of trauma, and severity of pelvic injuries were similar in the non-prolonged and prolonged ileus groups. As expected, the prolonged ileus group had a significantly longer duration of ileus than the non-prolonged ileus group (8.0 ± 4.2 days vs 1.2 ± 0.4 days, respectively; P < .001). The mortality rate was higher in the prolonged ileus group (20% vs 0%), but it was not significantly different (P = .13). Interestingly, the prolonged ileus group received significantly higher amounts of packed red blood cell transfusions (6.1 ± 2.1 units vs 3.8 ± 2.5 units; P = .02). The amount of packed red blood cell transfusions was associated with a greater risk of prolonged ileus development (P = .03, odds ratio = 2.04, 95% confidence interval = 1.08-3.88). This study supports the idea that the duration of the ileus is related with the amount of bleeding caused by the traumatic pelvic ring injury. In order to prevent further complications, conservative treatments of the ileus should be considered.
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Affiliation(s)
- Chan-Hee Park
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Woo Lee
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopaedic Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Myung-Rae Cho
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
- *Correspondence: Suk-Kyoon Song, Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, Republic of Korea (e-mail: )
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Li PH, Hsu TA, Kuo YC, Fu CY, Bajani F, Bokhari M, Mis J, Poulakidas S, Bokhari F. The application of the WSES classification system for open pelvic fractures-validation and supplement from a nationwide data bank. World J Emerg Surg 2022; 17:29. [PMID: 35624457 PMCID: PMC9145531 DOI: 10.1186/s13017-022-00434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Open pelvic fractures are rare but complex injuries. Concomitant external and internal hemorrhage and wound infection-related sepsis result in a high mortality rate and treatment challenges. Here, we validated the World Society Emergency Society (WSES) classification system for pelvic injuries in open pelvic fractures, which are quite different from closed fractures, using the National Trauma Data Bank (NTDB). Methods Open pelvic fracture patients in the NTDB 2015 dataset were retrospectively queried. The mortality rates associated with WSES minor, moderate and severe injuries were compared. A multivariate logistic regression model (MLR) was used to evaluate independent factors of mortality. Patients with and without sepsis were compared. The performance of the WSES classification in the prediction of mortality was evaluated by determining the discrimination and calibration. Results A total of 830 open pelvic fracture patients were studied. The mortality rates of the mild, moderate and severe WSES classes were 3.5%, 11.2% and 23.8%, respectively (p < 0.001). The MLR analysis showed that the presence of sepsis was an independent factor of mortality (odds of mortality 9.740, p < 0.001). Compared with patients without sepsis, those with sepsis had significantly higher mortality rates in all WSES classes (minor: 40.0% vs. 3.1%, p < 0.001; moderate: 50.0% vs. 9.1%, p < 0.001; severe: 66.7% vs. 22.2%, p < 0.001). The receiver operating characteristic (ROC) curve showed an acceptable discrimination of the WSES classification alone for evaluating the mortality of open pelvic fracture patients [area under curve (AUC) = 0.717]. Improved discrimination with an increased AUC was observed using the WSES classification plus sepsis (AUC = 0.767). Conclusions The WSES guidelines can be applied to evaluate patients with open pelvic fracture with accurate evaluation of outcomes. The presence of sepsis is recommended as a supplement to the WSES classification for open pelvic fractures.
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Affiliation(s)
- Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
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Fierro NM, Dhillon NK, Siletz AE, Muníz T, Barmparas G, Ley EJ, Hashim YM. Which Pelvic Fractures Are Associated With Extravasation on Angiography? Am Surg 2022; 88:2493-2498. [PMID: 35546075 DOI: 10.1177/00031348221101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bleeding from pelvic fractures can result in a high mortality rate unless quickly triaged by the trauma surgeon. Upon presentation, pelvic radiography may identify fractures that require angiography with possible embolization. We sought to address which fracture patterns seen on initial x-ray are associated with extravasation on angiography. METHODS Data from a single institution retrospective review were collected on trauma patients admitted from 2011 to 2018 with pelvic fractures that required angiography. These fractures were identified by initial pelvic x-ray in the trauma bay and include anteroposterior compression (APC), lateral compression (LC), vertical shear (VS), and combined mechanism (CM) fractures, which are graded by severity. Fracture patterns high risk for bleeding, defined as APC II, APC III, LC III, VS, and CM, were compared to low-risk fracture patterns. RESULTS Of the patients reviewed, 28 underwent pelvic angiography, 16 (57%) of which had extravasation. The difference in the incidence of extravasation between high and low-risk fracture patterns did not reach significance (36% vs 79%, P = .05). When comparing patients with acetabular fractures to those without, there was a significantly higher rate of extravasation associated with acetabular fractures (89% vs 42%, P value = .04), which were more likely to occur with LC I fractures (56% vs 11%, P = .02). CONCLUSION Our data suggest that traditional pelvic fracture patterns may overestimate the presence of extravasation. Acetabular fractures had a high rate of extravasation, suggesting that these fractures should be considered for early angiography with possible embolization when clinically warranted.
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Affiliation(s)
- Nicole M Fierro
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Navpreet K Dhillon
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anaar E Siletz
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tobias Muníz
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Galinos Barmparas
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Ley
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yassar M Hashim
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Leone E, Garipoli A, Ripani U, Lanzetti RM, Spoliti M, Creta D, Giannace C, Galluzzo A, Trinci M, Galluzzo M. Imaging Review of Pelvic Ring Fractures and Its Complications in High-Energy Trauma. Diagnostics (Basel) 2022; 12:diagnostics12020384. [PMID: 35204475 PMCID: PMC8870907 DOI: 10.3390/diagnostics12020384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 02/06/2023] Open
Abstract
Pelvic ring fractures are common in high-energy blunt trauma, especially in traffic accidents. These types of injuries have a high rate of morbidity and mortality, due to the common instability of the fractures, and the associated intrapelvic vascular and visceral complications. Computed tomography (CT) is the gold standard technique in the evaluation of pelvic trauma because it can quickly and accurately identify pelvic ring fractures, intrapelvic active bleeding, and lesions of other body systems. To properly guide the multidisciplinary management of the polytrauma patient, a classification criterion is mandatory. In this review, we decided to focus on the Young and Burgess classification, because it combines the mechanism and the stability of the fractures, helping to accurately identify injuries and related complications.
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Affiliation(s)
- Edoardo Leone
- Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (M.T.); (M.G.)
- Correspondence:
| | - Andrea Garipoli
- Department of Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Umberto Ripani
- Department of Emergency and Major Trauma, Division of Anaesthesia, Analgesia and Intensive Care and Pain Therapy, Ospedali Riuniti di Ancona, 60162 Ancona, Italy;
| | - Riccardo Maria Lanzetti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (R.M.L.); (M.S.)
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (R.M.L.); (M.S.)
| | - Domenico Creta
- Physical Medicine and Rehabilitation Service, Casa di Cura Privata Madre Fortunata Toniolo, 40141 Bologna, Italy;
| | | | - Antonio Galluzzo
- Department of Radiology, Università Degli Studi di Firenze, 50121 Florence, Italy;
| | - Margherita Trinci
- Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (M.T.); (M.G.)
| | - Michele Galluzzo
- Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (M.T.); (M.G.)
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Roessler MS, Buschmann C, Gliwitzky B, Hoedtke J, Kulla M, Wurmb T, Kleber C, Roessler M, Buschmann C, Brockmann J, Gliwitzky B, Hoedtke J, Kleber C, Koenig M, Kulla M, Molter E, Münzberg M, Wurmb T. Externe, nichtinvasive Beckenstabilisatoren – wann ist die Anlage indiziert? Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zapaishchykova A, Dreizin D, Li Z, Wu JY, Roohi SF, Unberath M. An Interpretable Approach to Automated Severity Scoring in Pelvic Trauma. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2021; 12903:424-433. [PMID: 37483538 PMCID: PMC10362989 DOI: 10.1007/978-3-030-87199-4_40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Pelvic ring disruptions result from blunt injury mechanisms and are often found in patients with multi-system trauma. To grade pelvic fracture severity in trauma victims based on whole-body CT, the Tile AO/OTA classification is frequently used. Due to the high volume of whole-body trauma CTs generated in busy trauma centers, an automated approach to Tile classification would provide substantial value, e. g., to prioritize the reading queue of the attending trauma radiologist. In such scenario, an automated method should perform grading based on a transparent process and based on interpretable features to enable interaction with human readers and lower their workload by offering insights from a first automated read of the scan. This paper introduces an automated yet interpretable pelvic trauma decision support system to assist radiologists in fracture detection and Tile grade classification. The method operates similarly to human interpretation of CT scans and first detects distinct pelvic fractures on CT with high specificity using a Faster-RCNN model that are then interpreted using a structural causal model based on clinical best practices to infer an initial Tile grade. The Bayesian causal model and finally, the object detector are then queried for likely co-occurring fractures that may have been rejected initially due to the highly specific operating point of the detector, resulting in an updated list of detected fractures and corresponding final Tile grade. Our method is transparent in that it provides finding location and type using the object detector, as well as information on important counterfactuals that would invalidate the system's recommendation and achieves an AUC of 83.3%/85.1% for translational/rotational instability. Despite being designed for human-machine teaming, our approach does not compromise on performance compared to previous black-box approaches.
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13
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Vaginal Laceration in an Open Pelvic Fracture Case Report: A Novel, Prophylactic Antibiotic Delivery Mechanism. Case Rep Orthop 2021; 2021:5594270. [PMID: 34055438 PMCID: PMC8112908 DOI: 10.1155/2021/5594270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/24/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Rotational displaced pelvic ring injuries are associated with internal injuries to both the gastrointestinal and genitourinary viscera and anatomic structures. Vaginal lacerations and open genitourinary-associated injuries are at increased risk of mortality due to sepsis. Case Presentation. This case presents a 65-year-old female status post-pedestrian-vehicle struck diagnosed with an open pelvic fracture with extension into the outer one-third of the vaginal wall. The patient was successfully treated with emergent surgical debridement, pelvic stabilization, and internal placement of a novel combination of metronidazole antibiotic gel and vancomycin/tobramycin Polymethyl methacrylate beads. Conclusion No evidence of infection was observed with the use of topical metronidazole-coated vancomycin/tobramycin Polymethyl methacrylate beads for contaminated open pelvic fracture injury involving the vaginal wall. Further research on antibiotic gels for use in high-risk open fractures is required.
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14
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Walton AB, Leinwand GZ, Raheem O, Hellstrom WJG, Brandes SB, Benson CR. Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature. J Sex Med 2021; 18:467-473. [PMID: 33593705 DOI: 10.1016/j.jsxm.2020.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/16/2020] [Accepted: 12/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Female sexual dysfunction (FSD) after pelvic fracture (PFx) has garnered little attention in the urology literature. AIM To review and summarize the current evidence regarding female PFx-related sexual function. METHODS We performed a systematic review in accordance with PRISMA guidelines, including PubMed, EMBASE, and MEDLINE. We included only English-language manuscripts and abstracts with sufficient data for inclusion. We used the search terms "female sexual dysfunction AND pelvic fracture," "sexual dysfunction AND pelvic fracture," and "female pelvic fracture AND sexual dysfunction." A total of 177 articles were identified; 41 abstracts were reviewed; of which, 19 manuscripts were reviewed. Fifteen met inclusion criteria for analysis. OUTCOMES The main outcome measures of this study are rates and types of female sexual dysfunction after pelvic fracture. RESULTS FSD is prevalent after PFx, with reported rates between 25% and 62%. Three studies used the validated Female Sexual Function Index. The other 12 used non-validated questionnaires or adapted quality-of-life questionnaires with specific questions regarding FSD. The most common complaints include difficulty with intercourse, dyspareunia, orgasmic dysfunction, genitourinary pain, decreased interest in intercourse, decreased satisfaction with intercourse, and pelvic floor dysfunction. Only 1 study addressed resolution of dysfunction (30 of 98 patients [30.4%]). CLINICAL IMPLICATIONS FSD is prevalent and an under-recognized sequela of pelvic fracture. This requires future prospective study to better characterize sexual dysfunction and identify effective treatments in trauma survivors. STRENGTH AND LIMITATIONS To Increase awareness of FSD after pelvic trauma and the impact on the quality of life in trauma survivors. The current literature is limited by a lack of standardized assessment of FSD, limited follow-up, and minimal discussion of treatment options, in addition to the inherent bias of retrospective studies. CONCLUSIONS FSD after traumatic PFx is not uncommon, occurs mostly in young women, and can be morbid. FSD after PFx is underreported in the urology literature. Thus, all female PFx patients should be screened for FSD by validated questionnaires. The published literature offers little knowledge as to the epidemiology, evaluation, definition, and potential treatments of FSD after PFx. Prospective studies are needed to better understand female sexual function in trauma survivors and the potential methods for prevention and rehabilitation, all within the context of a multidisciplinary approach. Walton AB, Leinwand GZ, Raheem O, et al. Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature. J Sex Med 2021;18:467-473.
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Affiliation(s)
- Alice B Walton
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Gabriel Z Leinwand
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Omer Raheem
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Steven B Brandes
- Columbia University Medical Center, Department of Urology, New York, NY, USA
| | - Cooper R Benson
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
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Dreizin D, Goldmann F, LeBedis C, Boscak A, Dattwyler M, Bodanapally U, Li G, Anderson S, Maier A, Unberath M. An Automated Deep Learning Method for Tile AO/OTA Pelvic Fracture Severity Grading from Trauma whole-Body CT. J Digit Imaging 2021; 34:53-65. [PMID: 33479859 PMCID: PMC7886919 DOI: 10.1007/s10278-020-00399-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023] Open
Abstract
Admission trauma whole-body CT is routinely employed as a first-line diagnostic tool for characterizing pelvic fracture severity. Tile AO/OTA grade based on the presence or absence of rotational and translational instability corresponds with need for interventions including massive transfusion and angioembolization. An automated method could be highly beneficial for point of care triage in this critical time-sensitive setting. A dataset of 373 trauma whole-body CTs collected from two busy level 1 trauma centers with consensus Tile AO/OTA grading by three trauma radiologists was used to train and test a triplanar parallel concatenated network incorporating orthogonal full-thickness multiplanar reformat (MPR) views as input with a ResNeXt-50 backbone. Input pelvic images were first derived using an automated registration and cropping technique. Performance of the network for classification of rotational and translational instability was compared with that of (1) an analogous triplanar architecture incorporating an LSTM RNN network, (2) a previously described 3D autoencoder-based method, and (3) grading by a fourth independent blinded radiologist with trauma expertise. Confusion matrix results were derived, anchored to peak Matthews correlation coefficient (MCC). Associations with clinical outcomes were determined using Fisher's exact test. The triplanar parallel concatenated method had the highest accuracies for discriminating translational and rotational instability (85% and 74%, respectively), with specificity, recall, and F1 score of 93.4%, 56.5%, and 0.63 for translational instability and 71.7%, 75.7%, and 0.77 for rotational instability. Accuracy of this method was equivalent to the single radiologist read for rotational instability (74.0% versus 76.7%, p = 0.40), but significantly higher for translational instability (85.0% versus 75.1, p = 0.0007). Mean inference time was < 0.1 s per test image. Translational instability determined with this method was associated with need for angioembolization and massive transfusion (p = 0.002-0.008). Saliency maps demonstrated that the network focused on the sacroiliac complex and pubic symphysis, in keeping with the AO/OTA grading paradigm. A multiview concatenated deep network leveraging 3D information from orthogonal thick-MPR images predicted rotationally and translationally unstable pelvic fractures with accuracy comparable to an independent reader with trauma radiology expertise. Model output demonstrated significant association with key clinical outcomes.
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Affiliation(s)
- David Dreizin
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | | | - Christina LeBedis
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Baltimore, MD USA
| | - Alexis Boscak
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Matthew Dattwyler
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Uttam Bodanapally
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Guang Li
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - Stephan Anderson
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Baltimore, MD USA
| | - Andreas Maier
- Friedrich-Alexander University, Schloßplatz, Erlangen Germany
| | - Mathias Unberath
- Department of Computer Science, Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD USA
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16
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Asmar S, Bible L, Chehab M, Tang A, Khurrum M, Douglas M, Castanon L, Kulvatunyou N, Joseph B. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. J Am Coll Surg 2020; 232:17-26.e2. [PMID: 33022396 DOI: 10.1016/j.jamcollsurg.2020.08.763] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pelvic hemorrhage is potentially lethal despite homeostatic interventions such as pre-peritoneal packing (PP), resuscitative endovascular balloon occlusion of the aorta (REBOA), surgery, and/or angioembolization. REBOA may be used as an alternative/adjunct to PP for temporizing bleeding in patients with pelvic fractures. Our study aimed to compare the outcomes of REBOA and/or PP, as temporizing measures, in blunt pelvic fracture patients. We hypothesized that REBOA is associated with worsened outcomes. STUDY DESIGN We performed a 2017 review of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) and identified trauma patients with blunt pelvic fractures who underwent REBOA placement and/or PP before laparotomy and/or angioembolization. Propensity score matching was performed, adjusting for demographics, vitals, mechanism of injury, ISS, each body region-AIS, and pelvic fracture type. Outcomes were complication rates and mortality. RESULTS A total of 156 patients (PP: 52; REBOA: 52; REBOA+PP: 52) were matched and included. Mean age was 43 ± 18 years, Injury Severity Score (ISS) was 28 (range 17-32), and 74% were males. Overall mortality was 42%. The 24-hour mortality (25% vs 14% vs 35%; p = 0.042), in-hospital mortality (44% vs 29% vs 54%; p = 0.034), and 4-hour pRBC units transfused (15 [9-23] vs 10 [4-19] vs 16 [9-27]; p = 0.017) were lower in the REBOA group. The REBOA group had faster times to both laparotomy (p = 0.040) and/or angioembolization (p = 0.012). There was no difference between the groups in acute kidney injury, lower limb amputations, or hospital and ICU length of stay among survivors. CONCLUSIONS REBOA is a less invasive procedure compared with PP and is associated with improved outcomes. Further clinical trials are needed to define the optimal patient who will benefit from REBOA.
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Affiliation(s)
- Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Molly Douglas
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
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Mostafa AMHAM, Kyriacou H, Chimutengwende-Gordon M, Khan WS. An overview of the key principles and guidelines in the management of pelvic fractures. J Perioper Pract 2020; 31:341-348. [PMID: 32894996 PMCID: PMC8406373 DOI: 10.1177/1750458920947358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient’s journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.
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Affiliation(s)
| | - Harry Kyriacou
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Wasim S Khan
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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Wu YT, Cheng CT, Tee YS, Fu CY, Liao CH, Hsieh CH. Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: the WSES classification for pelvic trauma makes sense. World J Emerg Surg 2020; 15:48. [PMID: 32807185 PMCID: PMC7433075 DOI: 10.1186/s13017-020-00328-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023] Open
Abstract
Background The most common cause of death in cases of pelvic trauma is exsanguination caused by associated injuries, not the pelvic injury itself. For patients with relatively isolated pelvic trauma, the impact of vascular injury severity on outcome remains unclear. We hypothesized that the severity of the pelvic vascular injury plays a more decisive role in outcome than fracture pattern complexity. Methods Medical records of patients with pelvic fracture at a single center between January 2016 and December 2017 were retrospectively reviewed. Those with an abbreviated injury scale (AIS) score ≥ 3 in areas other than the pelvis were excluded. Lateral compression (LC) type 1 fractures and anteroposterior compression (APC) type 1 fractures according to the Young-Burgess classification and ischial fractures were defined as simple pelvic fractures, while other fracture types were considered complicated pelvic fractures. Based on CT, vascular injury severity was defined as minor (fracture with or without hematoma) or severe (hematoma with contrast pooling/extravasation). Patient demographics, clinical parameters, and outcome measures were compared between the groups. Results Severe vascular injuries occurred in 26 of the 155 patients and were associated with poorer hemodynamics, a higher injury severity score (ISS), more blood transfusions, and a longer ICU stay (3.81 vs. 0.86 days, p = 0.000) and total hospital stay (20.7 vs. 10.1 days, p = 0.002) compared with minor vascular injuries. By contrast, those with complicated pelvic fractures (LC II/III, APC II/III, vertical shear, and combined type fracture) required a similar number of transfusions and had a similar length of ICU stay as those with simple pelvic fractures (LC I, APC I, and ischium fracture) but had a longer total hospital stay (13.6 vs. 10.3 days, p = 0.034). These findings were similar even if only patients with ISS ≥ 16 were considered. Conclusions Our results indicate that even in patients with relatively isolated pelvic injuries, vascular injury severity is more closely correlated to the outcome than the type of anatomical fracture. Therefore, a more balanced classification of pelvic injury that takes both the fracture pattern and hemodynamic status into consideration, such as the WSES classification, seems to have better utility for clinical practice.
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Affiliation(s)
- Yu-Tung Wu
- Department of Trauma and Emergency Surgery, Linkou branch of Chang Gung Memorial Hospital, 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Linkou branch of Chang Gung Memorial Hospital, 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Yu-San Tee
- Department of Trauma and Emergency Surgery, Linkou branch of Chang Gung Memorial Hospital, 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou branch of Chang Gung Memorial Hospital, 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou branch of Chang Gung Memorial Hospital, 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou branch of Chang Gung Memorial Hospital, 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan.
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19
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Abdelrahman H, El-Menyar A, Keil H, Alhammoud A, Ghouri SI, Babikir E, Asim M, Muenzberg M, Al-Thani H. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res 2020; 15:249. [PMID: 32646448 PMCID: PMC7344030 DOI: 10.1186/s13018-020-01772-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality. Purpose We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.
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Affiliation(s)
- Husham Abdelrahman
- Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. .,Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen am Rhein, Germany
| | | | - Syed Imran Ghouri
- Orthopedic Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Elhadi Babikir
- Orthopedic Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Matthias Muenzberg
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen am Rhein, Germany
| | - Hassan Al-Thani
- Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
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20
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Sandhu J, Abrahams R, Miller Z, Bhatia S, Zakrison TL, Mohan P. Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing. Eur Radiol 2020; 30:6376-6383. [PMID: 32518985 DOI: 10.1007/s00330-020-06965-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES (1) To identify the factors predicting arterial extravasation in pelvic trauma and (2) to assess the efficacy of preperitoneal pelvic packing (PPP) in controlling arterial hemorrhage. METHODS Institutional review board approved the retrospective study of 139 consecutive pelvic trauma patients who underwent angiographic intervention with or without prior PPP between January 2011 and December 2016. Patient demographics and presenting characteristics were recorded. Both groups of patients were combined for analysis of predictors for arterial extravasation using univariate logistic regression followed by multivariate logistic regression. Significance level was defined as p < 0.05. RESULTS Forty-nine out of 139 patients had PPP prior to pelvic angiogram. Embolization was performed in 85 (61.2%) patients and the technical and clinical success rate was 100%. Sixty-nine (49.7%) patients had unstable Young-Burgess (Y&B) type fractures, of which 58% had arterial hemorrhage compared with 38.6% of those with stable Y&B fractures (p = 0.02). Of the patients who had PPP prior to angiogram, 28(57.1%) continued to have arterial extravasation on subsequent angiography. Unstable Y&B type fractures are independent predictors of arterial hemorrhage (OR 2.3, 95%CI 1.1 to 4.7, p = 0.02). CONCLUSION Unstable Y&B type pelvic fractures are predictors of arterial extravasation. PPP alone is not effective for arterial hemorrhage control in pelvic trauma. Angiographic intervention remains a minimally invasive and definitive treatment of arterial hemorrhage from pelvic trauma. KEY POINTS • Unstable Young-Burgess pelvic fractures are predictors of arterial hemorrhage in pelvic trauma. • Pelvic angiography and embolization should precede PPP wherever feasible.
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Affiliation(s)
- Jagteshwar Sandhu
- University of Miami Miller School of Medicine, Miami, FL, USA. .,University of Miami Hospitals and Clinics, 1475 NW 12th Ave. Suite 1066-V, Miami, FL, 33136, USA.
| | - Robert Abrahams
- Diagnostic and Interventional Radiology, Haywood Medical Imaging, Clyde, NC, USA
| | - Zoe Miller
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shivank Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tanya L Zakrison
- Department of Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Prasoon Mohan
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Ianniello S, Conte P, Di Serafino M, Miele V, Trinci M, Vallone G, Galluzzo M. Diagnostic accuracy of pubic symphysis ultrasound in the detection of unstable pelvis in polytrauma patients during e-FAST: the value of FAST-PLUS protocol. A preliminary experience. J Ultrasound 2020; 24:423-428. [PMID: 32519303 DOI: 10.1007/s40477-020-00483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Extended focused abdominal sonography for trauma (e-FAST) is part of the primary survey in patients with high-energy trauma. However, it does not identify patients with retroperitoneal haemorrhage associated with significant pelvic trauma. A traumatic diastasis of pubic symphysis, as well as an 'open book' (OB) pelvic injury, is a diagnostic clue to recognize unstable pelvis with higher risk of bleeding. FAST-PLUS (FAST-PL pleural -US ultrasound of symphysis) protocol is an addendum to the e-FAST, which takes into account the study of the pubic symphysis in a single transverse scan after the traditional focused evaluation of the abdomen and thorax. OBJECTIVES The aim of this study is to determine the value of FAST-PLUS protocol in the evaluation of pubic symphysis injuries and the identification of 'open book' (OB) unstable pelvic fractures. METHODS Between January 2018 and December 2019, we retrospectively reviewed 67 polytraumatised patients with clinical suspicion of pelvic instability and with known anteroposterior pelvis compression injuries who underwent e-FAST with an additional transverse scan of the pubic symphysis, named the FAST-PLUS protocol and computed tomography (CT) exam in order to assess the correlation between them in defining the presence or absence of pubic symphyseal widening (SW). A cutoff value of 2.5 cm in transverse diameter was used to diagnose OB unstable pelvic injury. The results were analysed using Cohen's test, which uses the Kappa value as the reference index. RESULTS The analysis carried out to assess the degree of agreement between FAST-PLUS and CT showed 5/67 patients (7.5%) with a critical pubic SW (> 2.5 cm transverse diameter) suggestive of unstable OB pelvic injury and 62/67 (92,5%) without any signs of SW at FAST-PLUS. At CT, findings of unstable OB pelvic fracture were confirmed in all patients with positive results at FAST-PLUS. Similarly, all patients with negative results for critical pubic SW (< 2.5 cm in transverse diameter) at FAST-PLUS were found to be negative at CT exam. The level of correlation between the two methods was high (Kappa value = 1) CONCLUSION: The FAST-PLUS protocol shows a high correlation with CT exam, which is the gold standard for the detection of unstable pubic SW, as well as OB pelvic injury, in polytraumatised patients. Inclusion of FAST-PLUS in patient management in the shock room may lead to a quicker identification of patients with unstable pelvis and to faster therapeutic work-up.
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Affiliation(s)
- Stefania Ianniello
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy.
| | - Paola Conte
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Margherita Trinci
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
| | - Gianfranco Vallone
- Department of Life and Health, "Vincenzo Tiberio" University of Molise, Campobasso, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
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Zingg T, Piaget-Rossel R, Steppacher J, Carron PN, Dami F, Borens O, Albrecht R, Darioli V, Taffé P, Maudet L, Pasquier M. Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study. Sci Rep 2020; 10:5106. [PMID: 32198451 PMCID: PMC7083961 DOI: 10.1038/s41598-020-62027-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/06/2020] [Indexed: 11/20/2022] Open
Abstract
Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.
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Affiliation(s)
- Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
| | - Romain Piaget-Rossel
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Julie Steppacher
- School of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Fabrice Dami
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedics and Traumatology, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | | | - Vincent Darioli
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Patrick Taffé
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Ludovic Maudet
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
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Hammer M, Gutbrod A, Sigrist NE, Jacot V, Del Chicca F, Evans R, Pozzi A. Predictors of comorbidities and mortality in cats with pelvic fractures. Vet Surg 2019; 49:281-290. [PMID: 31876001 DOI: 10.1111/vsu.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/14/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize and evaluate risk factors for comorbidities and death of cats with pelvic fractures. STUDY DESIGN Retrospective case study. ANIMALS Cats (n = 280). METHODS Medical records were reviewed for cats in which pelvic fractures had been diagnosed (January 2003 to November 2016). Retrieved data included signalment, mechanism of injury, clinical findings, diagnostic imaging investigations, type and number of concurrent injuries based on anatomical location, type of therapy, and survival. Pelvic fractures were classified according to location and severity. Descriptive statistics were performed, and logistic regression models were constructed to examine associations between risk factors and outcome. RESULTS Cases consisted of 280 cats with no (9%), unilateral (43%), and bilateral (48%) involvement of the weight-bearing axis. Sacral fractures were found in 12% of cats. Surgical treatment and mortality rates increased progressively with the severity of the pelvic fractures (P < .001). Mean number of concurrent body regions injured was 2.4 ± 1.2 and was associated with mortality (P < .01). Twenty percent of cats did not survive to discharge. Cats with neurologic injuries were more likely not to survive (P = .02). CONCLUSION Concurrent injuries to at least one body region, especially the abdomen and thorax, were observed in cats sustaining pelvic fractures. Mortality was associated with increased severity of the fractures, neurologic injuries, and increased number of concurrent injuries. CLINICAL SIGNIFICANCE Concurrent injuries are common in cats with pelvic fractures, and comorbidities may be associated with mortality.
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Affiliation(s)
- Meike Hammer
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Nadja E Sigrist
- Division of Critical Care Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Francesca Del Chicca
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Antonio Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Abstract
Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.
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Affiliation(s)
- Jason V Brown
- Emergency Medical Services, United States Air Force, 96TW/SGOE, 307 Boatner Road, Eglin AFB, FL 32542, USA.
| | - Sharleen Yuan
- Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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Schmal H, Larsen MS, Stuby F, Strohm PC, Reising K, Goodwin Burri K. Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures. Injury 2019; 50:1959-1965. [PMID: 31477239 DOI: 10.1016/j.injury.2019.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate. PATIENTS AND METHODS The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n = 957 with vs n = 4,542 without). Furthermore, the subgroups with secondary surgery (n = 713 vs n = 1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n = 24 vs n = 219). Calculated odds ratios were adjusted for potential confounders. RESULTS Patients treated by CC/EF were younger (45 ± 20 vs 62 ± 24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3 mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p < 0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation. INTERPRETATION Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.
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Affiliation(s)
- Hagen Schmal
- Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark.
| | - Morten Schultz Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark.
| | | | - Peter C Strohm
- Clinic for Orthopaedics and Trauma Surgery, Sozialstiftung Bamberg, Buger Straße 80, 96049 Bamberg, Germany.
| | - Kilian Reising
- Department for Orthopaedic Surgery, University Teaching Hospital Harburg, Hamburg, Germany.
| | - Kelly Goodwin Burri
- Swiss medical Registries and Data Linkage (SwissRDL), Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
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Dreizin D. Commentary on "Multidetector CT in Vascular Injuries Resulting from Pelvic Fractures". Radiographics 2019; 39:2130-2133. [PMID: 31721653 PMCID: PMC6884065 DOI: 10.1148/rg.2019190192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- David Dreizin
- Department of Diagnostic Radiology and Nuclear Medicine, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine Baltimore, Maryland
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A Surgical Endovascular Trauma Service Increases Case Volume and Decreases Time to Hemostasis. Ann Surg 2019; 270:612-619. [DOI: 10.1097/sla.0000000000003486] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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El-Menyar A, Abdelrahman H, Alhammoud A, Ghouri SI, Babikir E, Asim M, Mekkodathil A, Al-Thani H. Prognostic Role of Shock Index in Traumatic Pelvic Fracture: A Retrospective Analysis. J Surg Res 2019; 243:410-418. [PMID: 31279267 DOI: 10.1016/j.jss.2019.05.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/13/2019] [Accepted: 05/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND We aimed to validate the utility of shock index (SI) in predicting the need of blood transfusion and outcomes in patients with traumatic pelvic fracture (TPF). MATERIALS AND METHODS We conducted a retrospective analysis for patients who sustained TPF between 2012 and 2016 in a level 1 trauma center. Patients were categorized into patients with low versus high SI based on the cutoff obtained from the receiver operating characteristic curves to predict mortality. RESULTS A total of 966 patients sustained TPF (28.5% had SI ≥ 0.9 based on receiver operating characteristic curves) with a median age of 33 (IQR 25-47) y. Type B and C pelvic fractures significantly had higher SI. The frequency of blood transfusion use was greater in patients with high SI (P = 0.001). SI correlated significantly with Injury Severity Score (r = 0.32), Revised Trauma Score (r = -0.40), and transfused blood units (r = 0.35). Patients with high SI had prolonged hospital length of stay and higher mortality (P = 0.001). SI ≥ 0.9 showed high sensitivity and negative predictive value to identify the need of massive blood transfusion (77% and 86%, respectively) and mortality (73.5% and 98.1%, respectively). For hospital mortality, high SI had a sensitivity of 73.5%, specificity 74%, negative predictive value 98%, and negative likelihood ratio of 0.36. After adjustment for age, sex, Injury Severity Score, Glasgow Coma Scale, pelvis Abbreviated Injury Scale, blood transfusion, and Tile classification, the multivariate analysis models showed that high SI was an independent predictor of blood transfusion (odd ratio 5.6) and mortality (odd ratio 3.63). CONCLUSIONS SI is a potentially useful instant tool for the prediction of massive transfusion and mortality in patients with TPF. Further prospective studies are warranted to support our findings.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Syed Imran Ghouri
- Depatment of Surgery, Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - ElHadi Babikir
- Depatment of Surgery, Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
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Gant P, Asztalos I, Kulendra E, Lee K, Humm K. Retrospective evaluation of factors influencing transfusion requirements and outcome in cats with pelvic injury (2009-2014): 122 cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:407-412. [PMID: 31218799 DOI: 10.1111/vec.12852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 06/28/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize a population of cats with pelvic trauma and evaluate factors influencing transfusion requirement and outcome. DESIGN Retrospective case series (2009-2014). SETTING University teaching hospital. ANIMALS One hundred twelve client-owned cats with pelvic trauma. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-one (18.8%) cats received a transfusion. Most cats required only 1 fresh whole blood transfusion (85.8%). Packed cell volume at admission was significantly lower in cats that required transfusion but was not associated with hospitalization time or survival to discharge. Increasing Animal Trauma Triage (ATT) score at admission was significantly associated with transfusion requirement (P = 0.0001) and nonsurvival to discharge (P = 0.03). Number of pelvic fractures was not associated with transfusion requirement but cats with sacroiliac luxations and pubic fractures were more likely to require a transfusion (P = 0.0015 and P = 0.0026, respectively). However, fracture type was not associated with survival to discharge. Most cats (86%) required a surgical procedure and half of transfusions were administered preoperatively. No surgical comorbidities were associated with transfusion requirement or survival. Transfusion requirement was associated with longer length of hospitalization but not survival to discharge. CONCLUSIONS Transfusion requirement in this population of cats with pelvic fractures was fairly high. Transfusion requirement was associated with lower packed cell volume, higher ATT score at admission, longer length of hospitalization, and certain types of pelvic fractures. Transfusion requirement was not associated with surgical comorbidities, surgical intervention, or survival to discharge. Lower ATT score at admission was associated with survival to discharge.
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Affiliation(s)
- Poppy Gant
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - Imola Asztalos
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - Elvin Kulendra
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - Karla Lee
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - Karen Humm
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
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Combined Pelvic Ring Disruption and Acetabular Fracture: Outcomes Using a Sequential Reduction Protocol and an Anterior Subcutaneous Pelvic Fixator (INFIX). J Orthop Trauma 2019; 33 Suppl 2:S66-S71. [PMID: 30688863 DOI: 10.1097/bot.0000000000001416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purposes of this article were to (1) compare our combined pelvic ring and acetabular fracture patients' rate of mortality and Injury Severity Score (ISS) to those of patients with isolated injuries at our center and to those with combined injuries as reported in the literature, (2) describe our treatment algorithm using the INFIX for these combination injuries, and (3) report our patients' radiographic and functional outcomes. DESIGN Retrospective IRB-approved case series and literature review. SETTING US Level 1 Trauma Center. PATIENTS/PARTICIPANTS Thousand six hundred ninety-seven with acetabular or pelvic ring injury, 174 patients with combination pelvic ring acetabular injuries, and 39 patients with 41 acetabular injuries treated with a surgical protocol. INTERVENTION Pelvic ring reduction using INFIX and posterior fixation followed by acetabular reduction fixation. Anterior injury fixed with INFIX. MAIN OUTCOME Mortality, ISS, pelvic reduction by Keshishyan index, acetabular reduction by the Matta criteria, and functional outcome by the Majeed score. RESULTS Mortality was 5.7% and ISS was 12.5 for 174 combined injury patients. In the 39 patients with 41 injuries, excellent pelvic reduction was found in 39, and acetabular reduction was anatomic in 25 (61%), imperfect in 12 (29%), and poor in 4 (10%). Clinically 78% of the patients had good or excellent outcome and 22% had a fair or poor outcome. Nonanatomic acetabular reduction, persistent sciatic nerve palsy, and heterotopic ossification associated with poor clinical outcome. CONCLUSIONS Our treatment protocol resulted in excellent pelvic reduction, anatomic acetabular reduction in 61% of patients, and 78% good to excellent clinical outcome. LEVEL OF EVIDENCE Case series Level IV.
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American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality. J Trauma Acute Care Surg 2019; 86:1-10. [DOI: 10.1097/ta.0000000000002062] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mohsenian L, Khoramian MK, Sadat Mazloom S. Prognostic Value of Arterial Blood Gas Indices Regarding the Severity of Traumatic Injury and Fractures of the Femur and Pelvis. Bull Emerg Trauma 2018; 6:318-324. [PMID: 30402520 PMCID: PMC6215061 DOI: 10.29252/beat-060408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: To evaluate the prognostic value of arterial blood gas (ABG) indices, especially base excess (BE), regarding the severity of traumatic injury. Methods: A total number of 96 trauma patients with fractures of femur and pelvis were included in this study. Demographic characteristics and clinical information of samples were recorded. The results of ABG test and hemoglobin (Hb) were evaluated at two time intervals (on admission and 6 hours later). The outcome of the patients was evaluated at the end of the study (dead or alive). The ABG indices included O2 saturation (O2Sat), PH, PO2, PCO2, bicarbonate (HCO3) and base excess (BE). The mean of the hemodynamic and ABG indices were compared between those who were discharged and mortality cases. The confounders were compensated using a multivariate logistic regression model. Results: Overall 94 trauma patients with long and pelvic fractures were included. There were 69 (73.4%) men and 25 (26.6%) women among the patients with mean age of 37.43 ± 20.07 years. The mortality rate was 10 (10.6%). The most common mechanism of injury was motorcycle accident in 41 (43.6%) and car collision in 43 (45.7%) patients. We found that mortality was significantly associated with amount of FFP transfusion (p=0.005), but was not associated with amount of transfused packed cells (p=0.113). We also found that mortality was associated with lower BP after 6 hours of admission (p=0.001), higher HR on admission (p=0.036), lower HR after 6 hours (p=0.017), lower O2Sat on admission (p<0.001), higher PCO2 after 6 hours and lower BE on admission (p=0.025). Conclusion: The ABG indices including O2Sat, BE and PCO2 are considered prognostic determinants of outcome in trauma patients with long and pelvic fractures. These findings can be considered as fundamental studies to achieve new diagnostic methods.
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Affiliation(s)
- Leila Mohsenian
- Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sara Sadat Mazloom
- Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Aaran LHC, Him CK, Bong LK, Wilson L. Outcome of Haemodynamically Unstable Open Pelvic Fracture Patients Managed with “3-in-1” Pelvic Damage Control Protocol in a Major Trauma Centre. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2018. [DOI: 10.1016/j.jotr.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Open pelvic fractures are one of the most challenging and severe injuries of orthopaedics. These patients usually are associated with high mortality and morbidity. Therefore, multiple studies have suggested different methods to deal with this challenging problem. Our hospital is one of the few trauma centers in Hong Kong that deals with these patients. We have developed a “3-in-1” pelvic damage control protocol that strategically treats patients with pelvic injuries with open fractures. This article aims to review the outcomes of patients suffering from open pelvic fractures, admitted from January 2011 to 2016. Patients & Methods All patients diagnosed with hemodynamically unstable open fracture admitted from January 2011 to 2016 were retrospectively reviewed. All these patients were treated with our hospital's “3-in-1” pelvic damage control protocol. We analyzed their demographics, associated injuries, Injury Severity and final outcomes. Results Twelve consecutive patients were included in this study. Seventy-five percent (n = 9) of them were successfully resuscitated and discharged from hospital as their final outcome. Conclusion Our hospital's “3-in-1” pelvic damage control protocol improves the survival rate of patients suffering from haemodynamically unstable open fracture, including open fracture. External fixation of pelvis, retroperitoneal packing and emergency angiography with embolization play important and inseparable roles in management of these critical patients. Adequate wound lavage, timely urinary and faecal diversion will improve the overall morbidity and survival further.
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Affiliation(s)
| | - Chui King Him
- Orthopaedics and Traumatology Department, Queen Elizabeth Hospital, Hong Kong
| | - Lee Kin Bong
- Orthopaedics and Traumatology Department, Queen Elizabeth Hospital, Hong Kong
| | - Li Wilson
- Orthopaedics and Traumatology Department, Queen Elizabeth Hospital, Hong Kong
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Ju YU, Cho JM, Kim NR, Lee KB, Kim JK, Oh JK. Analysis of the Importance of Sacroiliac Joint Fractures as a Prognostic Factor of the Patients with Pelvic Fractures. JOURNAL OF TRAUMA AND INJURY 2018. [DOI: 10.20408/jti.2018.31.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yeon-Uk Ju
- Department of General Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jun-Min Cho
- Department of General Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Nam-Ryeol Kim
- Department of General Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Kyung-Bum Lee
- Department of General Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jin-Kak Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
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Abstract
OBJECTIVES To document in-hospital and 1-year mortality rates after high-energy pelvic fracture in patients 65 years of age or older as compared to a younger cohort. DESIGN Retrospective review. SETTING Urban Level 1 academic trauma center. PATIENTS Seventy consecutive patients 65 years of age and older treated for pelvic fracture resulting from high-energy mechanism from 2008 to 2011. A total of 140 patients 18-64 years of age were matched to the study population based on mechanism of injury and OTA Code 61 subtype for comparison. INTERVENTION Review of demographics, injury characteristics, hospital management, and mortality. MAIN OUTCOME MEASUREMENTS Mortality. RESULTS The overall inpatient mortality rate was 10%. The older cohort exhibited an inpatient mortality rate 3 times higher than the younger cohort (18.6% vs. 5.7%, P = 0.003). There was no difference in mortality 1 year post discharge (5.3% vs. 3.8%, P = 0.699). No significant differences in initial Glasgow Coma Scale or Injury Severity Score were identified (GCS 12.9 vs. 12.4, P = 0.363; ISS 24.7 vs. 23.4, P = 0.479). Multivariate analysis identified the Charlson Comorbidity Index (CCI) (P = 0.012) and Abbreviated Injury Scale (AIS)-chest (P = 0.005) as independent predictors of in-hospital mortality, and CCI (0.005) and AIS-abdomen (0.012) for 1-year mortality. CONCLUSIONS After controlling for mechanism of injury and pelvic fracture classification, we found that adults ≥65 and those with multiple comorbidities were more likely to die in the hospital than younger adults. However, mortality within 1-year postdischarge was low and did not differ between groups. This is in sharp contrast to the high rates of postdischarge mortality observed in elderly patients with a hip fracture. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Lai YC, Wu CH, Chen HW, Wang LJ, Wong YC. Predictors of active arterial hemorrhage on angiography in pelvic fracture patients. Jpn J Radiol 2017; 36:223-230. [PMID: 29282615 DOI: 10.1007/s11604-017-0716-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/17/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE To determine predictors of active angiographic hemorrhage in pelvic fracture patients. MATERIALS AND METHODS This retrospective study included 66 trauma patients who had major hemorrhages due to pelvic fractures, and who underwent pelvic angiography between January 2012 and December 2014. The study population comprised 31 males and 35 females (mean age 44.2 ± 20.7 years). The main outcome was active hemorrhage on pelvic angiography. Clinical and imaging variables including demographics, hemodynamic parameters, injury severity, types of pelvic fracture, laboratory data, blood transfusions and CT findings were analyzed. Multivariate logistic regression was used to identify predictors of active angiographic hemorrhage. RESULTS Of the 66 study patients included, 41 patients had active angiographic hemorrhage. These patients had more blood transfusions, higher activated partial thromboplastin times and higher rates of contrast extravasation on CT (p < 0.05). Three independent predictors of active angiographic hemorrhage were identified, including contrast extravasation on CT (OR: 74.6, p < 0.001), more than 8 units of RBC transfusions (OR: 12.5, p = 0.018) and ISS ≥ 16 (OR: 11.1, p = 0.029). CONCLUSION Contrast extravasation on CT, high volume RBC transfusions and ISS ≥ 16 can help us to select pelvic fracture patients for angiography more precisely.
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Affiliation(s)
- Ying-Chieh Lai
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan
| | - Cheng-Hsien Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan
| | - Li-Jen Wang
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan
| | - Yon-Cheong Wong
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan.
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Abstract
Severe pelvic trauma is a challenging condition. The pelvis can create multifocal hemorrhage that is not easily compressible nor managed by traditional surgical methods such as tying off a blood vessel or removing an organ. Its treatment often requires reapproximation of bony structures, damage control resuscitation, assessment for associated injuries, and triage of investigations, as well as multimodality hemorrhage control (external fixation, preperitoneal packing, angioembolization, REBOA [resuscitative endovascular balloon occlusion of the aorta]) by multidisciplinary trauma specialists (general surgeons, orthopedic surgeons, endovascular surgeons/interventional radiologists). This article explores this complex clinical problem and provides a practical approach to its management.
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Affiliation(s)
- Steven Skitch
- Department of Emergency Medicine, McMaster University, Hamilton General Hospital, 6 North Wing - Room 616, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; Department of Critical Care, McMaster University, Hamilton General Hospital, 6 North Wing - Room 616, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada
| | - Paul T Engels
- Department of Critical Care, McMaster University, Hamilton General Hospital, 6 North Wing - Room 616, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; Department of Surgery, McMaster University, Hamilton General Hospital, 6 North Wing - Room 616, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
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38
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Agri F, Bourgeat M, Becce F, Moerenhout K, Pasquier M, Borens O, Yersin B, Demartines N, Zingg T. Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study. BMC Surg 2017; 17:104. [PMID: 29121893 PMCID: PMC5680776 DOI: 10.1186/s12893-017-0299-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures. Methods Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed. Results The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates. Conclusions Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.
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Affiliation(s)
- Fabio Agri
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Mylène Bourgeat
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Kevin Moerenhout
- Department of Orthopedic Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedic Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Yersin
- Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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39
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Rich JA, Coleman J, Devaux C, Hoffman K. Acute rehabilitation after resuscitative endovascular balloon occlusion of the aorta (REBOA) in major trauma. BMJ Case Rep 2017; 2017:bcr-2017-220885. [PMID: 28716775 DOI: 10.1136/bcr-2017-220885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a 23-year-old woman admitted post cyclist versus heavy goods vehicle accident in December 2014. This was the second case the life-saving procedure, that is, resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed on at the roadside. This advanced procedure was performed due to the extensive haemorrhage from this patient's complex pelvic fracture . As a result of REBOA, the patient consequently lost her left lower limb and underwent a variety of complex pelvic and lower limb surgeries.The patient was admitted to the acute critical care unit and underwent repeated operations and was not ready to start active rehabilitation until 12 days into her admission. Prior to this she was on movement restrictions and received physiotherapy for limb care and dietetics in order to meet her nutritional requirements. The patient was stepped down to a ward setting and started on an extensive physiotherapy programme and was then transferred to the rehabilitation unit for amputees at Roehampton.
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Affiliation(s)
- Jessica Anne Rich
- Department of Inpatient Physiotherapy, Barts Health NHS Trust, London, UK
| | - Julia Coleman
- Royal London Hospital , Barts Health NHS Trust, London, UK
| | - Camille Devaux
- Department of Inpatient Physiotherapy, Barts Health NHS Trust, London, UK
| | - Karen Hoffman
- Royal London Hospital , Barts Health NHS Trust, London, UK
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Corrêa WO, Batista VGR, Cavalcante Júnior EF, Fernandes MP, Fortes R, Ruiz GZL, Machado CJ, Pastore Neto M. Preditores de mortalidade em pacientes com fratura de pelve por trauma contuso. Rev Col Bras Cir 2017; 44:222-230. [DOI: 10.1590/0100-69912017003001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a associação de mortalidade com variáveis sociodemográficas, clínicas, lesões e complicações em pacientes com trauma de pelve decorrente de trauma contuso. Métodos: estudo retrospectivo e observacional com dados de registro de trauma obtidos durante cinco anos. O óbito foi a variável de estratificação das análises. Para verificar se as variáveis de interesse tinham associação com o óbito, foi realizado o teste t de Student e teste do Qui-quadrado (ou Fisher) e Wilcoxon-Mann Whitney. Os fatores independentemente associados ao óbito foram analisados por modelo logístico binomial, e com base nos testes de Wald e por Critérios de Informação de Akaike (AIC) e Bayesiano de Schwarz (BIC). Resultados: dos 28 pacientes com fratura de pelve por trauma contuso, 23 (82,1%) eram homens; 16 (57,1%) com média de idade de 38,8 anos (desvio padrão 17,3). Houve 98 lesões ou fraturas nos 28 pacientes. Quanto à gravidade, sete pacientes tiveram Injury Severity Score superior a 24 (25%). O tempo de internação hospitalar médio foi 26,8 dias (DP=22,4). Quinze pacientes (53,6%) tiveram internação em UTI. A incidência de óbito foi de 21,4%. A análise mostrou que idade igual ou maior do que 50 anos e presença de coagulopatia foram fatores independentemente associados ao óbito. Conclusão: as fraturas de pelve podem ter mortalidade elevada. Neste estudo a mortalidade foi superior ao que é descrito na literatura. A idade acima de 50 anos e a coagulopatia se revelaram fatores de risco nessa população.
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Alfayez SM, Allimmia K, Alshammri A, Serro F, Almogbel R, Bin Dous A, Almannie R, Palencia J. Urological injuries associated with pelvic fractures: A case report of a detached bone segment inside the bladder. Int J Surg Case Rep 2016; 28:188-191. [PMID: 27718438 PMCID: PMC5061300 DOI: 10.1016/j.ijscr.2016.09.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/04/2022] Open
Abstract
A 45-year-old pedestrian male was hit by a car. Gross hematuria was evident upon inserting Foley’s catheter. CT revealed multiple stable pelvic fractures. CT cystogram showed intraperitoneal and extraperitoneal extravasation of contrast. A detached pubic bone fragment was found inside the urinary bladder.
Introduction Urological injuries in pelvic fractures are noticed in 6–15% of the cases. The bladder, due to its anatomical position, is prone to rupture in pelvic fractures. The majority of urinary bladder injuries are either extraperitoneal or intraperitoneal. Nonetheless, both types can occur simultaneously in 6% of the cases. Presentation of the case A 45-year-old male was brought to our emergency department after being struck by an automobile. In the absence of signs of urethral injury, a Foley’s catheter was inserted revealing gross hematuria. The radiological assessment showed bilateral non-displacement sacral wing fractures, bilateral non-displacement anterior column fractures and bilateral comminuted superior and inferior pubic rami fractures, with a detached pubic bone fragment displaced posteriorly. A CT cystogram was performed showing intraperitoneal and extraperitoneal extravasation of contrast. The patient was taken to surgery. A sharp-edged bony fragment was discovered inside the bladder. A two-layer closure of the bladder was performed. Discussion Pelvic fractures with concomitant lower urinary tract injuries are associated with high morbidity and mortality. The signs indicative of bladder rupture include a more than one centimeter diastasis of the symphysis pubis and a displaced fracture of more than one centimeter involving the obturator ring. However, the signs may not be present as in our case. Conclusion This unusual case illustrates the potential risk of bladder injury following stable pelvic fractures through a detached bone segment. It also emphasizes on having a high index of suspicion. The teamwork and multidisciplinary approach are essential for an optimal outcome.
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Affiliation(s)
- Saud M Alfayez
- Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Khalid Allimmia
- Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmad Alshammri
- Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Firas Serro
- Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rakan Almogbel
- Orthopedic Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Bin Dous
- Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raed Almannie
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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INFIX/EXFIX: Massive Open Pelvic Injuries and Review of the Literature. Case Rep Orthop 2016; 2016:9468285. [PMID: 27493818 PMCID: PMC4963555 DOI: 10.1155/2016/9468285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction. Open pelvic fractures make up 2–5% of all pelvic ring injuries. Their mortality has been reported to be as high as 50%. During Operation Enduring Freedom protocols for massive open pelvic injuries lead to the survival of injuries once thought to be fatal. The INFIX is a subcutaneous anterior fixator for pelvic stabilization which is stronger than external fixation. The purpose of this paper is to describe the use of INFIX and modern algorithms for massive open pelvic injuries. Methods. An IRB approved retrospective review describes 4 cases in civilian practice with massive open pelvic injuries. We also review the modern literature on open pelvic injures. Discussion. Key components in the care of massive open pelvic injuries include hemorrhage control by clamping of the aorta or REBOA when necessary and fecal/urinary diversion. The INFIX can be used internally, as a partial INFIX partial EXFIX, or as an EXFIX. Its low profile allows for easy application of wound vacs and wound care and when subcutaneous avoids pin tract infections. Conclusion. Massive open pelvic injuries are a difficult problem. Following modern protocols can help prevent mortality.
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