Proposal of standardization of every step of angiographic procedure in bleeding patients from pelvic trauma

Aging Influences Fracture Healing on the Cellular Level and Alters Systemic RANKL and OPG Concentrations in a Murine Model

Clinical complications frequently follow polytrauma and bleeding fractures, increasing the risk of delayed fracture healing and nonunions, especially in aged patients. Therefore, this study examines age's impact on fracture repair with and without severe bleeding in mice. Young (17-26 weeks) and aged (64-72 weeks) male C57BL/6J mice (n = 72 in total, n = 6 per group) are allocated into 3 groups: the fracture group (Fx) undergoes femur osteotomy stabilized via external fixator, the combined trauma group (THFx) additionally receives pressure-controlled trauma hemorrhage (TH) and Sham animals are implanted with catheter and fixator without blood loss or osteotomy. Femoral bones are evaluated histologically 24 h and 3 weeks post-trauma, while RANKL/OPG and β-CTx are measured systemically via ELISA after 3 weeks. Aging results in less mineralized bone and fewer osteoclasts within the fracture of aged mice in contrast to young groups after three weeks. Systemically, aged animals exhibit increased RANKL and OPG levels after fracture compared to their young counterparts. The RANKL/OPG ratio rises in aged Fx animals compared to young mice, with a similar trend in THFx groups. In conclusion, age has an effect during the later course of fracture healing on the cellular and systemic levels.

Availability and use of resources for emergency fracture care of pelvic trauma associated with haemorrhagic shock in Latin America: A cross-sectional study

Determining the true availability of resources and understanding the level of training of surgeons involved in the treatment of patients with pelvic fractures and haemorrhagic shock is critical. In the herein study, the availability of technical, technological, and human resources for the care of this injury in Latin America region was analysed, and the preferences of orthopaedic trauma surgeons when performing interventions for the diagnosis and treatment of patients with pelvic trauma and associated haemorrhagic shock was described. A cross sectional web-based survey containing questions on knowledge, attitudes, and practices with respect to imaging resources, emergency pelvic stabilization methods, and interventions used for bleeding control was sent to 948 Latin America orthopaedic trauma surgeons treating pelvic fractures in the emergency department. Differences between regional clusters, level of training, type of hospital, and pelvic surgery volume were assessed. 368 responses were obtained, with 37.5% of respondents reporting formal training in pelvic surgery and 36.0% having available protocol for managing these patients. The most frequently used interventions were the supra-acetabular pelvic external fixator and pelvic packing. Limited hospital and imaging resources are available for the care of patients with pelvic trauma and associated haemorrhagic shock throughout Latin America. In addition, the training of orthopaedic trauma surgeons dealing with this type of injury and the volume of pelvic surgeries per year is heterogeneous. It should be urgently considered to develop management protocols adapted to Latin America according to the availability of resources, as well as to promote training in this severe life-threatening traumatic condition.

Transcatheter Arterial Embolization for Bleeding Related to Pelvic Trauma: Comparison of Technical and Clinical Results between Hemodynamically Stable and Unstable Patients

BACKGROUND

Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity associated with surgery and can swiftly access and control bleeding sites. Despite international guidelines and widespread awareness of the role of angioembolization in clinical practice, robust evidence comparing the outcomes of angioembolization in hemodynamically stable and unstable patients is still lacking. This study aims to directly compare the outcomes of angioembolization for the treatment of pelvic traumatic arterial injury in patients with hemodynamic stability vs. hemodynamic instability.

METHODS

In our multicenter retrospective investigation, we analyzed data from consecutive patients who underwent, from January 2020 to May 2023, angioembolization for traumatic pelvic arterial injury.

RESULTS

In total, 116 angioembolizations were performed. Gelatin sponges (56.9%) and coils (25.9%) were the most widely used embolic agents. The technical and clinical success rates were 100% and 91.4%, respectively. No statistically significant differences were observed between the two groups in terms of technical success, clinical success, procedure-related complication rate, or 30-day bleeding-related mortality.

CONCLUSIONS

Angioembolization is an effective and safe option for the management of traumatic pelvic arterial lesions even in hemodynamically unstable patients, despite technical variations such as greater use of prophylactic angioembolization.