Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Hemorrhage Management

Background:

• Pelvic fractures are common in severe trauma, with high mortality despite modern treatments.
• Fractures disrupt the pelvic ring, impairing tamponade and causing retroperitoneal hemorrhage, leading to hemodynamic instability.
• Hemorrhage is primarily venous (80%) from pre-sacral plexuses, with arterial sources (internal iliac branches) comprising 20%.

Purpose of the Study:

• To present sequential management algorithms for pelvic hemorrhage.
• To tailor approaches based on available resources and infrastructure in trauma facilities.
• To improve outcomes for patients with severe pelvic fractures.

Main Methods:

• Development of two distinct management algorithms for pelvic hemorrhage.
• Algorithm 1: designed for fully equipped trauma centers.
• Algorithm 2: designed for limited-resource settings, emphasizing collaboration between orthopedic, trauma, and intensive care surgeons.

Main Results:

• The proposed algorithms provide a structured approach to managing pelvic hemorrhage.
• Management strategies are adaptable to different healthcare environments.
• Focus on sequential management aims to mitigate risks associated with pelvic fractures.

Conclusions:

• Effective management of pelvic hemorrhage requires a collaborative, sequential approach.
• Tailoring treatment algorithms to facility resources is crucial for improving patient survival.
• Standardized protocols can enhance care for severe pelvic trauma patients.