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Pelvic Fractures

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Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures.
Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM, Fox CJ, Campion EM, Johnson JL, Mauffrey C.
J Trauma Acute Care Surg. 2017 Feb;82(2):233-242.

Rationale for inclusion: In 128 patients who underwent preperitoneal packing, the authors demonstrated shorter time to intervention and decreased mortality when compared to other contemporary series.

Citations - 2 (as of July 2017)

Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures.
Burlew CC, Moore EE, Smith WR, Johnson JL, Biffl WL, Barnett CC, Stahel PF.
J Am Coll Surg. 2011 Apr;212(4):628-35; discussion 635-7.

Rationale for inclusion: Additional support for preperitoneal packing, this study concluded that packing and external fixation is effective in the early treatment of life-threatening pelvic hemorrhage from fractures and can reduce the need for secondary embolization significantly as well as serve as a temporizing measure to allow transport to definitive care.

Citations - 99 (as of July 2017)

Direct retroperitoneal pelvic packing versus pelvic angiography: A comparison of two management protocols for hemodynamically unstable pelvic fractures.
Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AE, Stahel PF.
Injury. 2009 Jan;40(1):54-60.

Rationale for inclusion: A retrospective review of a prospectively collected dataset, this study confirmed that pelvic packing is as effective as angiography and embolization in the management and stabilization of hemodynamically unstable patients with pelvic fractures.

Citations - 162 (as of July 2017)

Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift.
Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR.
J Trauma. 2007 Apr;62(4):834-9; discussion 839-42.

Rationale for inclusion: This study is the sentinel paper introducing the use of preperitoneal packing for rapid control of pelvic hemorrhage, describing 28 consecutive patients with significant reduction in transfusion and mortality.

Citations - 288 (as of July 2017)

External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage.
Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC.
J Trauma. 2003 Mar;54(3):437-43.

Rationale for inclusion: To identify patients who may benefit from early angiography prior to pelvic stabilization, this study found that non-responders to resuscitative efforts and those patients with CT evidence of contrast blush have potential arterial hemorrhage that should be treated with early embolization.

Citations - 289 (as of July 2017)

The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions.
Eastridge BJ, Starr A, Minei JP, O'Keefe GE, Scalea TM.
J Trauma. 2002 Sep;53(3):446-50; discussion 450-1.

Rationale for inclusion: This study addressed the complexity of managing hemodynamically unstable patients with combined pelvic and abdominal trauma, concluding that stable pelvic fracture patterns would benefit from initial laparotomy, and unstable pelvic fracture patterns (APC II, APC III, LC II, LC III, and vertical shear) may benefit from initial angiography even in the presence of hemoperitoneum.

Citations - 304 (as of July 2017)

Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures.
Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T, Offner PJ, Ray CE Jr, Franciose RJ, Burch JM.
Ann Surg. 2001 Jun;233(6):843-50.

Rationale for inclusion: The authors describe a clinical pathway incorporating immediate orthopedic evaluation in addition to trauma surgery presence in the emergency department, early transfusion of blood and plasma, prompt diagnosis of associated injuries, stabilization of the pelvis, and timely angiography with embolization, resulting in improved patient survival.

Citations - 300 (as of July 2017)

Pelvic ring disruptions: effective classification system and treatment protocols.
Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ.
J Trauma. 1990 Jul;30(7):848-56.

Rationale for inclusion: Using a classification system that accounted for vector of force and pelvic fracture pattern, 210 patients were used to generate treatment protocols for each type to reduce the morbidity and mortality from pelvic trauma.  Anteroposterior compression fractures were associated with the highest transfusion requirements and mortality.

Citations - 723 (as of July 2017)

Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome.
Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D, Bathon H.
J Trauma. 1989 Jul;29(7):981-1000; discussion 1000-2.

Rationale for inclusion: In this study, the authors evaluated 343 complex multi-system trauma patients and successfully identified patterns of force and pelvic fractures that provide reliable predictions to organ injury patterns and anticipated mortality.  

Citations - 400 (as of July 2017)

Hemorrhage associated with major pelvic fracture: a multispecialty challenge.
Moreno C, Moore EE, Rosenberger A, Cleveland HC.
J Trauma. 1986 Nov;26(11):987-94.

Rationale for inclusion: This series from the 1980s described 538 patients with pelvic fractures, utilizing many adjuncts provided by multiple disciplines including external fixation, laparotomy, angiography, with overall 26% mortality.

Citations - 291 (as of July 2017)

Pelvic fractures: value of plain radiography in early assessment and management.
Young JW, Burgess AR, Brumback RJ, Poka A.
Radiology. 1986 Aug;160(2):445-51.

Rationale for inclusion: This retrospective analysis of radiographs by Burgess from 142 patients with pelvic fractures identified and introduced four patterns of force:  anteroposterior compression, lateral compression, vertical shear, and complex.  

Citations - 405 (as of July 2017)

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