Unstable Pelvic Ring Fractures: From Bleeding Control to Bone Repair Along the Trauma Pathway

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Emergency Medicine

Background:

• Unstable pelvic ring fractures present complex challenges, including significant hemorrhage and multi-organ involvement.
• Effective management requires a coordinated approach from prehospital care through definitive surgical repair.

Purpose of the Study:

• To critically evaluate the indications, timing, and synergistic application of pre-peritoneal pelvic packing (PPP), angioembolisation (AE), external fixation (ExFix), and open reduction internal fixation (ORIF).
• To optimize outcomes for patients suffering from unstable pelvic ring fractures.

Main Methods:

• Literature review assessing current evidence on hemorrhage control and fracture stabilization techniques.
• Analysis of the combined use of PPP, AE, ExFix, and ORIF in managing pelvic ring injuries.

Main Results:

• Pre-peritoneal pelvic packing (PPP) is crucial for rapid venous bleeding control in the prehospital setting.
• Angioembolisation (AE) effectively targets arterial hemorrhage sources.
• Timely external fixation (ExFix) and subsequent open reduction internal fixation (ORIF) are vital for bone repair and minimizing long-term complications.

Conclusions:

• A multidisciplinary approach coordinating prehospital and surgical interventions is essential for managing unstable pelvic ring fractures.
• Optimizing the timing and synergistic use of PPP, AE, ExFix, and ORIF can improve patient survival and functional recovery.
• Advancements in trauma network systems hold potential for enhancing outcomes in these complex injuries.