Clinical and radiographic predictors for angiography in pelvic trauma: An analysis of 1703 patients
Christoffer JohansenVicente A. MejiaMarinda G. ScrushySimon TizianiPeter C. CannamelaBing WanLinda A. DultzMichael W. CrippsDavid J. SandersArnold StarrJudith GrantChan Park
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Pelvic fracture
Objective:To provide the theoretical basis on selecting optimal fixing direction in the treatment of open book pelvic fracture according to biomechanical comparison in different fixing direction of pelvic external fixator. Methods:The models of open book pelvic fractures were fixed by pelvic external fixator in different fixing direction,which were used for biomechamics determination. Results:When fixing direction of pelvic external fixator was paralleled with the plane of superior aperture of the pelvis, the pelvic stability was a significant difference (P0.05). Conclusion:Fixing direction of the pelvic external fixator in the treatment of open book pelvic fracture was paralleled with the plane of superior aperture of the pelvis,Its fixing effect was the best.
Pelvic fracture
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Objective To investigate the features of multiple pelvic injuries (fracture combined with multiple traumas) and their effects on management and prognosis. Methods A total of 233 cases of hemodynamically unstable pelvic fractures were grouped according to the patterns of violence, fracture and associated injuries. They were assessed with measured indexes in physiological state, anatomic injury and blood requirement. Their possibilities of survival (Ps) were also predicted. All the data were statistically analyzed. Results The pelvic fractures were often combined with multiple traumas and frequently resulted from high energy traffic accidents. The correlations among sources of bleeding, amounts of blood loss and hemodynamical changes were disproportional. In unstable pelvic fractures with extra pelvic bleeding, BP and blood requirement were significantly different, and their AIS and ISS of the pelvis were higher and their Ps was lower than in the other groups. Conclusions Multiple pelvic injuries caused by high energy are often highly risky and combined with multiple traumas and several sources of bleeding. A clear and precise assessment of the total injuries and sources of bleeding will help treat the patients with different managements.
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Pelvic fracture
Pelvic girdle
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Trauma is still the leading cause of death in children. Post mortem studies have shown a high incidence and a high rate of deaths related to pelvic fractures and associated injuries. The pelvic ring in children has characteristics that differentiate it from the adult. The bone tissue is more elastic and is covered with a thick periosteum. Elasticity mainly translates into plastic deformity when it is impacted. Overall, lesions tend to be more stable as the relatively thick periosteum limits bone breakdown. As a result of this elasticity, the intrapelvic organs are more vulnerable and injuries can occur in the absence of fractures. High energy is required to produce a fracture and this energy can be transferred to the pelvic organs. Minimally displaced fractures may be the result of high energy trauma with a significant risk of further intrapelvic and intra-abdominal injury. This leads to a relatively high incidence of pelvic and abdominal organ injuries associated with stable fractures. A complete lesion of the pelvic ring anteriorly or posteriorly or a complex pelvic lesion is a high risk factor for morbidity and mortality. Treatment in the pediatric patient with a pelvic fracture has historically been guided by concepts that have become established in adults. The main parameters in the decision making process are hemodynamic stability and the degree of mechanical instability of the pelvis. The purpose of this review is to report current knowledge on pelvic ring fractures with a particular focus on their management and treatment.
Pelvic fracture
Periosteum
Insufficiency fracture
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Pelvic fracture
Fracture reduction
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The pelvic ring fractures (PRF) are commonly induced by the high-energy impact and will lead to unstable and sever injures. This study is aimed to explore the stability of anterior external fixation in treating pelvis fracture and evaluate the possibility for these kinds of patients to reduce bedridden time.A patient with Tile B3 pelvis fracture was chosen in the research and the corresponding digital model was reconstructed according to the CT images and 3D scanning. Four angles of pelvis under vertical compression were employed in the finite element (FE) analyses. The stress distribution and micro-motion displacement were calculated to validate the instability of pelvis.The stress applied on the pelvis was ranged from 4.296 to 8.364 MPa in all postures. The stress applied on pins was less than 7.011 MPa during reclining, and reached 28.29 MPa when standing. The micro-motion displacement in reclining posture was ranged from 0.005 to 0.087 mm. The value increased to more than 1mm in standing posture.It was safety for patients with pelvis fracture to sit vertical or recline on the bed during nursing or having treatment, but standing or walking will generate inappropriate micro-motion. The existence of external fixation can reduce the possibility of complications caused by long-term bedridden.
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Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients’ ongoing care in the emergency department.
Pelvic fracture
High energy
Trauma care
Falling (accident)
Major trauma
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Pelvic fracture associated with viscera injuries accompanies with a notable increase of morbidity and mortality.Damage control surgery principle is stressed in the management of severe pelvic fracture associated with viscera injuries.To deal with such patients,a wise sequence is as follows:controlling massive hemorrhage from pelvis by devascularization of internal iliac arteries and external fixation,and treating associated viscera injuries by emergent laparotomy;improving hemodynamics and ventilation as well as correcting lethal triad in ICU;and finally performing a definitive reconstruction of the pelvis and certain injured viscera.
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Damage control
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Secure fixation by inserting a half-pin into the iliac crest as a pelvic external fixator is important. However, the thickness of the iliac bone depends on its location and this makes it difficult to insert a half-pin accurately. The iliac crest is especially narrow in the paediatric pelvis, making it difficult to insert the half-pin accurately compared with an adult pelvis. A case of pelvic external fixation is described for a paediatric pelvic fracture in this report, in which preoperative planning for half-pin insertion was performed accurately using a preoperative three-dimensional CT based on an intraoperative support device that uses the functional pelvic plane as a reference.
Iliac crest
Pelvic fracture
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Pelvic x-ray is a routine part of the primary survey of Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard in the diagnosis of pelvic fractures. This study aims to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis, in favour of later pelvic CT scan.
A retrospective analysis of polytraumatized patients in our emergency room was conducted between 2005 and 2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and clinically stable pelvis. We excluded patients requiring immediate intervention.
We reviewed the records of 452 patients. 91 fulfilled inclusion criteria (56% male, mean age 45 years). 43% were road traffic accidents and 47% falls. In 68/91 (75%) patients, both pelvic x-ray and CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None false positive pelvic x-ray was detected. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confirmed on CT. 5 (56%) were classified type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classification). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23).
In hemodynamically stable patients with clinically stable pelvis, x-ray sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination. The results support the safety and utility of our modified ATLS algorithm
Pelvic fracture
Blunt trauma
Gold standard (test)
Pelvic examination
Pelvic cavity
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