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Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift
C Clay Cothren1, Patrick M Osborn, Ernest E Moore
1Department of Surgery, Denver Health Medical Center, Dencer, CO 80204, USA. clay.cothren@dhha.org
The Journal of Trauma
|April 12, 2007
Summary
Direct preperitoneal pelvic packing (PPP) controls pelvic fracture hemorrhage, reducing angiography needs and blood transfusions. This technique appears to lower mortality in high-risk hemodynamically unstable patients.
Area of Science:
- Trauma Surgery
- Surgical Critical Care
- Emergency Medicine
Background:
- Hemodynamically unstable pelvic fracture patients face high mortality (40%) despite current US management.
- Venous bleeding accounts for 85% of pelvic fracture hemorrhage, necessitating alternative therapies.
- European trauma groups advocate pelvic packing via laparotomy for hemorrhage control.
Purpose of the Study:
- To evaluate a modified technique of direct preperitoneal pelvic packing (PPP).
- To determine if PPP reduces the need for angiography and blood transfusions.
- To assess the impact of PPP on mortality in hemodynamically unstable pelvic fracture patients.
Main Methods:
- A protocol of PPP combined with external fixation was implemented for hemodynamically unstable pelvic fracture patients.
- Data collected included patient demographics, injury severity, hemodynamic parameters, and transfusion requirements.
- Statistical analysis used Student's t test for mean comparisons.
Main Results:
- Twenty-eight patients underwent PPP; the majority were male with severe injuries and shock.
- Mean packed red blood cell (PRBC) transfusion was significantly lower in the 24 hours post-PPP compared to pre-PPP.
- Angiography and angioembolization rates decreased post-PPP implementation.
- Mortality was 25%, with no deaths attributed to acute blood loss.
Conclusions:
- Direct preperitoneal pelvic packing (PPP) is an effective method for controlling pelvic fracture hemorrhage.
- PPP can reduce the requirement for emergent angiography and decrease blood product transfusions.
- This technique shows promise in reducing mortality for high-risk pelvic fracture patients.
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