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Related Experiment Video

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Preperitoneal pelvic packing: Technique and outcomes.

Dina M Filiberto1, Adam D Fox2

  • 1Rutgers University NJMS, Department of General Surgery, Residency Office, 185 South Orange Avenue, MSB G-512, Newark, NJ 07103, USA.

International Journal of Surgery (London, England)
|July 5, 2016
PubMed
Summary

Significant pelvic ring fractures cause high mortality due to blood loss. Hemorrhage control is key, with angiography and embolization for arterial bleeds and preperitoneal pelvic packing for venous bleeding in unstable patients.

Keywords:
Preperitoneal pelvic packing

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Area of Science:

  • Trauma surgery
  • Emergency medicine
  • Orthopedic surgery

Background:

  • Significant pelvic ring fractures result from high-energy trauma and are associated with high mortality rates (40-60%), primarily due to acute blood loss within the first 24 hours.
  • The main sources of pelvic hemorrhage are presacral venous plexus disruption and bony fracture sites, with arterial injury occurring in only 10-15% of cases.
  • Optimal management for hemodynamically unstable patients with pelvic fractures remains a critical area of clinical debate.

Approach:

  • Management principles involve resuscitation, external pelvic stabilization, and hemorrhage control.
  • Hemorrhage control strategies include angiography and embolization (AE) and/or preperitoneal pelvic packing (PPP).
  • The EAST guidelines support AE for arterial bleeding in unstable pelvic fracture patients.

Key Points:

  • Venous bleeding accounts for the majority of hemorrhage in pelvic trauma.
  • Preperitoneal pelvic packing (PPP) offers a life-saving alternative for venous hemorrhage control, particularly when AE is not readily accessible.
  • Both AE and PPP are crucial components in the algorithm for managing life-threatening pelvic hemorrhage.

Conclusions:

  • Effective hemorrhage control is paramount in reducing mortality associated with severe pelvic fractures.
  • Preperitoneal pelvic packing (PPP) is a vital technique for managing venous bleeding in hemodynamically unstable patients.
  • A multimodal approach combining resuscitation, stabilization, and targeted hemorrhage control is essential for improving outcomes in pelvic trauma.