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Comparison of Timing of Definitive Pelvic Fixation in Pelvic Fracture Treated with Preperitoneal Pelvic Packing or
Junsik Kwon1,2, Timothy Allison-Aipa1, Bishoy Zakhary1
1From the Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA (Kwon, Allison-Aipa, Zakhary, BC Coimbra, Firek, R Coimbra).
Insights
Preperitoneal pelvic packing (PPP) does not delay pelvic fracture fixation. However, PPP is linked to higher mortality and increased hospital resource use compared to angioembolization (AE).
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Orthopedic Surgery
Background:
- Preperitoneal pelvic packing (PPP) and angioembolization (AE) are key treatments for bleeding pelvic fractures.
- Concerns exist regarding potential delays in definitive pelvic fracture fixation associated with PPP.
Purpose of the Study:
- To compare the timing of definitive internal fixation between patients receiving PPP and those undergoing AE.
- To evaluate secondary outcomes including mortality and resource utilization.
Main Methods:
- Retrospective cohort study using the TQIP database (2017-2021).
- Included adults with isolated pelvic fractures requiring transfusion within 24 hours.
- Used inverse probability of treatment weighting to adjust for confounding variables.
Main Results:
- No significant difference in time to definitive internal fixation between PPP and AE groups (median 51.4 vs 37.5 hours; p=0.071).
- Higher in-hospital mortality in the PPP group (4.4% vs 0.6%; p=0.009).
- PPP associated with longer ICU/hospital stays, increased ventilation, and higher rates of acute kidney injury and severe sepsis.
Conclusions:
- PPP does not significantly delay definitive internal fixation for pelvic fractures.
- PPP use may be associated with increased complications and resource utilization compared to AE.
Background:
Preperitoneal pelvic packing (PPP) and angioembolization (AE) are current hemostatic techniques in patients with bleeding pelvic fracture. Concerns exist that PPP may delay definitive internal fixation of pelvic fractures. This study aimed to determine whether PPP results in delayed internal fixation compared with AE.
Study Design:
A retrospective cohort study was conducted using the TQIP database from 2017 to 2021. Adults with isolated pelvic fractures requiring transfusion within 24 hours were included. Patients underwent internal fixation and received either PPP (90) or AE only (253). Inverse probability of treatment weighting was used to adjust for confounding variables. The primary outcome was time from admission to internal fixation; secondary outcomes included in-hospital mortality and hospital resource use.
Results:
Time to definitive fixation was not significantly different between groups (PPP median 51.4 hours vs AE median 37.5 hours; p = 0.071). In-hospital mortality was higher in the PPP group (4.4% vs 0.6%; p = 0.009). The PPP group had longer ICU and hospital stays, extended mechanical ventilation duration, and higher rates of acute kidney injury and severe sepsis. No significant difference in transfusion volume within 4 hours was observed between the groups.
Conclusions:
PPP does not significantly delay definitive internal fixation. However, the implementation of PPP for patients with pelvic fractures may be associated with increased complications and hospital resource use compared with AE alone as a hemostatic measure.
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