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Preperitoneal pelvic packing is effective for hemorrhage control in open pelvic fractures
Eliza E Moskowitz1, Clay Cothren Burlew1, Ernest E Moore1
1Department of Surgery, Denver Health Medical Center and the University of Colorado Denver, Denver, CO, United States.
Insights
Preperitoneal pelvic packing (PPP) effectively controls hemorrhage in open pelvic fractures, reducing mortality. This study supports its use in unstable patients with pelvic injuries.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Surgical Critical Care
Background:
- Open pelvic fractures present significant hemorrhage risks.
- Preperitoneal pelvic packing (PPP) efficacy for open fractures is debated.
- Hypothesis: PPP improves hemorrhage control and survival in open pelvic fractures.
Purpose of the Study:
- To evaluate the effectiveness of preperitoneal pelvic packing (PPP) for hemorrhage control.
- To assess the impact of PPP on mortality rates in patients with open pelvic fractures.
Main Methods:
- Retrospective analysis of patients undergoing PPP (2005-2015).
- Definition of open pelvic fractures: direct communication with soft tissue, vagina, or rectum.
- Inclusion criteria: patients undergoing PPP for pelvic fracture hemorrhage control.
Main Results:
- 126 patients underwent PPP; 14 had open pelvic fractures.
- Hemorrhage control achieved in all patients post-PPP.
- Low mortality rate (7%), with one death attributed to traumatic brain injury.
Conclusions:
- Preperitoneal pelvic packing (PPP) is effective for hemorrhage control in open pelvic fractures.
- PPP should be integrated into standard protocols for hemodynamically unstable patients with pelvic fractures.
Background:
Open pelvic fractures are life-threatening injuries. Preperitoneal pelvic packing (PPP) has been suggested to be ineffective for hemorrhage control in open pelvic fractures. We hypothesize that PPP is effective at hemorrhage control in patients with open pelvic fractures and reduces mortality.
Methods:
Patients undergoing PPP from 2005 to 2015 were analyzed. Patients with open pelvic fractures were defined as direct communication of the bony injury with overlying soft tissue, vagina, or rectum.
Results:
During the 10-year study, 126 patients underwent PPP; 14 (11%) sustained an open pelvic fracture. After PPP, 1 patient (7%) underwent angioembolization with a documented arterial blush. PPP controlled pelvic hemorrhage in all patients. Overall mortality rate was 7% with one death due to traumatic brain injury.
Conclusions:
PPP is effective for hemorrhage control in patients with open pelvic fractures. PPP should be used in a standard protocol for hemodynamically unstable patients with pelvic fractures regardless of associated perineal injuries.
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