[Damage Control Surgery in Polytrauma Patients with Pelvic Fractures. Is It Possible to Use Internal Fixation?]

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Emergency Medicine

Background:

• Polytrauma management employs Damage Control Surgery (DCS), Damage Control Orthopaedics (DCO), and Damage Control Resuscitation (DCR) in initial patient care.
• Patients with circulatory instability and massive blood loss due to unstable pelvic fractures represent the most critical polytrauma subgroup.
• Rapid and effective stabilization of pelvic fracture fragments is paramount in managing these severe cases.

Observation:

• The authors report on two polytrauma cases involving unstable pelvic fractures.
• Open reduction and internal fixation of the anterior fracture segment were performed via extended laparotomy.
• This surgical intervention was integrated into the Damage Control Surgery (DCS) protocol to mitigate abdominopelvic hemorrhage.

Findings:

• Surgical fixation of anterior pelvic fracture segments through extended laparotomy can effectively control exsanguination.
• This DCS approach addresses severe bleeding associated with unstable pelvic fractures in polytrauma patients.
• Plate fixation was utilized for stabilizing the pelvic fracture fragments in the presented cases.

Implications:

• Extended laparotomy with open reduction and internal fixation may be a viable component of DCS for hemodynamically unstable polytrauma patients with pelvic fractures.
• This strategy can rapidly control intra-abdominal and pelvic bleeding, improving outcomes in exsanguinating patients.
• Further investigation into the role of surgical fixation within DCS for pelvic trauma is warranted.