medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2012, Number 5

<< Back Next >>

Acta Ortop Mex 2012; 26 (5)

Pelvic fractures: early management of hemodinamically unstable patients

Fernández-Palomo LJ

Language: Spanish
References: 20
Page: 275-281
PDF size: 180.17 Kb.


ABSTRACT

Introduction: Fractures that compromise pelvic and/or acetabular mechanical stability are usually injuries caused by high energy mechanisms and are life threatening. Objective: To present the treatment options for the early stabilization of pelvic rim injuries and acetabular fractures in hemodinamically unstable patients. Material and Methods: Retrospective, cross-sectional, descriptive study in patients with diagnosis of pelvic ring or acetabular fracture and hemodynamic instability seen in the emergency room between January 2002 and December 2010. The mechanisms of injury were identified and the following variables were considered: sex, age, type of fracture, time course, associated injuries, early and definitive management. Results: Fifteen patients were included; 9 with pelvic fracture, and 6 with acetabular fracture or both, who had hemodynamic instability resulting from hypovolemia: 8 males (53.3%) and 7 females (46.6%) with an age range of 18-72 years. The most common mechanism of injury was motor vehicle accident in 8 cases (53.3%), motorcycle accident in 2 (13.3%), fall in 2 (13.3%), and being run over in 3 patients (20%). All of them had associated injuries. Initial management consisted of external fixation with a standard fixator in 6 cases; C clamp in one case; girdle-like pelvic bandage in 2; laparotomy with packing and definitive primary osteosynthesis in one case. Results were assessed after a minimum of 3 years and were classified into excellent, 10 (76.9%) good, 1 (7.7%) fair, 0 and poor 1 (7.7%). One female patient (7.7%) died 8 hours after admission. Conclusion: Unstable pelvic or acetabular fractures are injuries produced mostly by high energy mechanisms and are life threatening in most cases. Initial management is extremely important for treatment course and final outcome. In cases that present initially with hemodynamic instability mortality is higher and management should be much more aggressive.


REFERENCES

  1. González O, Fernández PLJ: Mortalidad por fracturas de pelvis y acetábulo en el Centro Médico ABC. An Med Asoc Med Hosp ABC 2002; 47(2): 62-6.

  2. Tile M: Describing the injury: classification of pelvic ring fractures. In: Tile M (ed): Fractures of the pelvis and acetabulum. Baltimore: Lippincott Williams & Wilkins; 2003: 145.

  3. Letournel E: Classification. In: Letournel E, Judet R (ed). Fractures of the acetabulum. 2nd ed. Berlin: Springer-Verlag; 1993: 63-6.

  4. Hak DV, Smith WR, Susuki T: Management of hemorrhage in life-threatening pelvic fractures. J Am Acad Orthop Surg 2009; 17: 447-57.

  5. Balogh Z, Caldwell E, Heetveld M, et al: Instructional practice guidelines on management of pelvic fracture-related hemodynamic instability: Do they make a difference? J Trauma 2005; 58: 778-82.

  6. Fernández PLJ, Fernández VJM: Evaluación radiográfica de la pelvis. An Med Asoc Med Hosp ABC 2001; 47(2): 91-7.

  7. Matta J, Mehne DK, Roofi R: Fractures of the acetabulum. Early results of a prospective study. Clin Orthop and Relat Res 1994; 305: 10-9.

  8. Fernández PLJ: Nueva clasificación para la luxación traumática de la cadera. Rev Mex Ortop Traum 2001; 15(6): 280-7.

  9. American College of Surgeons. Committeeon Trauma: Advanced trauma life support program for doctors: ATLS. 6th ed. Universidad de Michigan; 1997. [Digitalizado el 1° de agosto de 2008]

  10. Routt ML Jr, Falicov A, Woodhouse E, Schildauer TA: Circumferential pelvic antishock sheeting: a temporar resuscitation aid. J Orthop Trauma 2002; 16: 45-8.

  11. Bottling M, Krieg JC, Mohr M, Simpson TS, Made SM: Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg AM 2002; 84(Supple 2): 43-7.

  12. Croce MA, Menotti LJ, Savage SA, Wood GW II, Fabian TC: Emergent pelvic fixation in patients with exsanguinations pelvic fractures. J Am Coll Surg 2007; 204: 935-42.

  13. Gang R, Russell RJ, Jacob RP, Chuffer J: The antishock pelvic clamp. Clin Orthop Relat Res 1991; 267: 71-8.

  14. Retell W, Keel M, Plats A, Trent O: Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 2001; 15: 468-74.

  15. Matta J, Saucedo T: Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 1989; 242: 83-97.

  16. Matta J, Torrente P II: Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 1996; 329: 129-40.

  17. Fernández PLJ: Evaluación radiográfica de las fracturas acetabulares. Acta Ortop Mexicana 2005; 19(5): 236-44.

  18. Weinlein J, Schmidt AH: What´s new in orthopaedic trauma. J Bone Joint Surg Am 2010; 92(12): 2247-60.

  19. Knops SP, Schep NW, Spoor CW, et al: Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am 2011; 93(3): 230-40.

  20. Sathy AK, Star AJ, Smith WR, et al: The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am 2009; 91(12): 2803-10.




2020     |     www.medigraphic.com