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[Classification and management of complex pelvic trauma]
1Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Insights
Complex pelvic trauma, involving fractures and soft tissue damage, has high mortality. A new grading system and trauma algorithm improve treatment by assessing fractures, soft tissue injuries, and patient stability.
Area of Science:
- Traumatology
- Orthopedic Surgery
- Emergency Medicine
Context:
- Complex pelvic traumas involve both pelvic fractures and significant soft tissue injuries.
- High mortality rates are associated with these injuries, primarily due to uncontrolled bleeding and sepsis.
- Existing fracture grading systems inadequately address the severity of associated soft tissue damage.
Purpose:
- To develop and introduce a novel grading system for complex pelvic traumas that incorporates soft tissue damage.
- To present a trauma algorithm for improved primary management of patients with complex pelvic injuries.
- To review the clinical course and outcomes of patients treated for complex pelvic traumas.
Summary:
- A new point-based grading system considers pelvic fractures, soft tissue injuries (including pelvic organs, vessels, nerves), and concomitant injuries.
- A trauma algorithm guides therapeutic steps based on clinical, ultrasonic, and radiological assessments, prioritizing pelvic ring stability and hemodynamic status.
- Review of 132 patients (1972-1990) showed 34.8% mortality; 62.9% underwent laparotomy and 51.7% had open reduction and internal fixation for unstable pelvic rings.
Impact:
- The developed grading system and trauma algorithm aim to enhance the primary treatment and outcomes for complex pelvic injuries.
- Immediate laparotomy, hemorrhage control, and surgical fixation of unstable pelvic rings are critical for successful management.
- This approach addresses the complex therapeutic challenges and reduces mortality associated with severe pelvic trauma.
Abstract:
Complex pelvic traumas are pelvic fractures accompanied by pelvic soft tissue injuries. Mortality in major pelvic fractures with associated soft tissue injuries is high, and these injuries can pose a more complex range of therapeutic problems. Uncontrolled bleeding and septic complications are the main causes of death. There has been extensive work on grading pelvic ring fractures, but less attention has been paid to grading the accompanying soft tissue damage. Therefore, a grading system for pelvic injuries was developed that takes the soft tissue damage into account more than the fracture classification did when used alone. It is a point system that considers the fracture itself, the soft tissue injuries, including lesions in the pelvic organs, vessels and nerves, and the general concomitant injuries. From 1972 to 1990 the clinical course and outcome of 132 patients with complex pelvic traumas were reviewed. The mortality was 34.8%. Eighty-three of the patients (62.9%) underwent immediate laparotomy and in 68 patients (51.7%) open reduction and internal fixation of the unstable pelvic ring were performed. For better primary treatment of patients with complex pelvic injuries, a trauma algorithm is introduced. It leads to important therapeutic steps after brief clinical, ultrasonic and radiological assessments. The major questions in the flow chart take the pelvic ring and hemodynamic instability into account. Immediate laparotomy, surgical control of hemorrhage, and open reduction and internal fixation of an unstable pelvic ring represent the most important requirements for successful treatment.