[Primary management of pelvic injuries]

Area of Science:

• Trauma surgery
• Orthopedic surgery
• Emergency medicine

Context:

• High-energy pelvic fractures frequently involve severe soft tissue damage and associated injuries to genitourinary, neurological, vascular, and intestinal systems.
• These complex injuries present significant challenges in assessment, stabilization, and definitive treatment, often leading to high mortality rates.
• Uncontrolled hemorrhage and septic complications are primary causes of death in patients with complex pelvic injuries.

Purpose:

• To present a trauma algorithm aimed at improving the primary hospital treatment of patients with complex pelvic injuries.
• To outline decisive therapeutic steps based on clinical, radiological, and ultrasonographical assessments, prioritizing pelvic ring stability and hemodynamic status.
• To reduce mortality associated with severe pelvic fractures through timely and effective interventions.

Summary:

• A trauma algorithm was developed to guide the management of complex pelvic injuries, focusing on rapid assessment, hemorrhage control, and surgical stabilization.
• The algorithm incorporates clinical evaluation, imaging, and hemodynamic assessment to direct immediate interventions such as laparotomy and pelvic ring fixation.
• A review of 132 patients demonstrated a significant decrease in mortality from 66.7% to 18.7% after implementing changes to the treatment protocol.

Impact:

• The implemented trauma algorithm and revised treatment protocols led to a substantial reduction in mortality for complex pelvic injuries.
• Improved management strategies, including early surgical control of hemorrhage and fixation of pelvic ring disruptions, are critical for patient survival.
• This study highlights the importance of a systematic approach to managing high-energy pelvic fractures to improve patient outcomes and reduce fatalities.