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Damage Control for Severe Pelvic Haemorrhage in Trauma
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Kristin Hummel, John H. Armstrong
As previously emphasised, recognition of exsanguinating haemorrhage in the injured patient is the first critical step in management. The mechanism of injury will define the amount and vector of energy that has caused the injury and, therefore, the potential for bleeding. A rapid diagnosis of pelvic fracture begins with clinical examination. Palpation along the pelvic margins may elicit tenderness in the lucid patient. Perineal bruising, blood at the urethral meatus, and a high-riding prostate (absent prostate on digital rectal exam) may be additional clues of pelvic fracture but in themselves are not reliable. It is not recommended to manually mobilise the pelvis (i.e. ‘springing the pelvis’ or ‘open-booking the pelvis’) to assess for A-P stability as this has the potential to exacerbate bleeding. A rapid anterior-posterior plain radiograph of the pelvis gives a snapshot of the fracture patterns described earlier. A FAST (focused assessment with sonography for trauma) scan may also demonstrate free fluid (i.e. blood) in the pelvis and abdomen but is not reliable to rule out pelvic bleeding.
The Pelvis
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Pelvic fractures may be due to low or high energy trauma, and consist of pelvic ring fractures and acetabular fractures, mainly due to blunt trauma. The likelihood of associated injuries in high energy trauma is 65%, usually involving the abdominal and pelvic viscera. In the haemodynamically unstable patient with severe pelvic fracture, there is a 90% risk of associated injury, a 50% risk of extra-pelvic bleeding, and a 30% risk of intra-abdominal bleeding.
Urethra and Penis
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The most common causes of pelvic fracture are road traffic accidents, severe crush injuries and falls. Typically there are multiple associated injuries that may be immediately life threatening and the overriding priority is to keep the patient alive by appropriate resuscitation. Under these circumstances the management of the other injuries takes precedence.
The incidence of pelvic fractures and related surgery in the Finnish adult population: a nationwide study of 33,469 patients between 1997 and 2014
Published in Acta Orthopaedica, 2020
Pasi P Rinne, Minna K Laitinen, Pekka Kannus, Ville M Mattila
The exact reasons for the rise in the elderly population’s and especially elderly female population’s age-specific incidence are unclear. The comparison between the crude incidence rate and age-standardized incidence rate shows that the changed age distribution does not explain all of the increase in incidence. Pelvic fractures in the elderly population are mostly low-energy fragility fractures that are related to falling and osteoporosis. The age structure of the Finnish population is changing and the mean age of the population is becoming older: the mean life expectancy in Finland was rising constantly during the study period (Statistics Finland 2017). People in Finland are also living longer at home. Impaired muscle strength, balance problems, physical inactivity, and degenerative joint diseases are common in the elderly population, and increase the risk of falling. Osteoporosis increases the fracture risk when falling. As pelvic fractures occur more frequently in the growing elderly population, the increase in the number and the incidence of fracture is expected to keep on rising.
Prehospital trauma care evolution, practice and controversies: need for a review
Published in International Journal of Injury Control and Safety Promotion, 2020
Three phases of triage have emerged in modern health care systems. First, prehospital triage in order to dispatch ambulance and prehospital care resources. Second, triage at scene by the first clinician attending the patient. Third, triage on arrival at emergency department or receiving hospital (Robertson-Steel, 2006). To reduce the errors in triaging different services use different protocols. Kane's ‘revised’ checklist provided the largest improvement in odds against needing a trauma centre when the triage instrument is negative. Of the triage instruments with a sensitivity greater than 70%, the respiratory/systolic pressure/Glasgow Coma Scale (RSG) score provided the largest improvement in odds for needing a trauma centre when the triage instrument is positive (Hedges, Feero, Moore, Haver, & Shultz, 1987). A CDC panel in 2009 also recommended transport to a trauma centre if any of the following are identified: Glasgow Coma Scale of <14, Systolic BP <90, respiratory rate (RR) <10 or >29 breaths per minute (children, 20 in infants <1 year). The panel also recommends transport to a trauma centre if the following were seen: 1. all penetrating injuries to head, neck, torso and extremities proximal to elbow and knee; 2. flail chest; 3. two or more proximal long-bone fractures; 4. crushed, degloved or mangled extremity; 5. amputation proximal to wrist and ankle; 6. pelvic fractures; 7. open or depressed skull fracture; or 8. paralysis.
Influence of energy absorbers on Malgaigne fracture mechanism in lumbar-pelvic system under vertical impact load
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
K. Arkusz, T. Klekiel, G. Sławiński, R. Będziński
The analysis of pelvic fracture mechanism is crucial due to its high mortality, and the massive coexisting injuries (WHO 2015). The most common pelvic fracture is Malgaigne fracture characterised by breaking the continuity of the pelvic ring (Gokalp et al. 2016). To date, the mechanism of pelvic fracture in anteroposterior and lateral compression have been well known (Salzar et al. 2009; Lopez-Valdes et al. 2014). To our knowledge, very few studies on the pelvic shear fracture focusing on the explosion of an IED under the military vehicle or directly under the soldiers were performed (Song et al. 2016; Mackiewicz et al. 2016; Klekiel et al. 2017). This type of accident is the best map of shearing forces acting on pelvic girdle due to the vertical direction of load and high velocity.