RSULTS OF A MULTIDISCIPLINARY CLINICAL PATHWAY FOR THE TREATMENT OF PELVIC FRACTURES WITH HEMODINAMIC INSTABILITY: ANALYSIS OF SIXTY CONSECUTIVE CASES

Abstract

The aim of present study was to evaluate the clinical evolution of a series of 60 pelvic fractures with uncontrolled hypotension treated with combined ex fix/angio algorithm based on fracture pattern.

Materials and Methods: Retrospective study. We analysed 60 patients admitted between 2000 and 2008 with pelvic fracture and haemodinamic instability, treated by the same treatment algorithm. Decision-making (angio vs external fixation) was based on fracture type and hypotensive pattern. Key points were: immediate pelvic sheeting, early CT scan if possible and early arteriogram if contrast blushing in CT. Patients with rotationally unstable fractures were treated by external fixation and those with vertically unstable or stable pattern were transferred to angio suite. Patients with hemoperitoneum detected by fast were transferred to OR for laparotomy and external fixation.

Inclusion criteria: pelvic fracture, SAP< 90mmHg, ISS> 16, RBT > 800cc in first 24 hours. Exclusion criteria: Traumatic brain injury with AIS> 3.

Results: Mean ISS: 31.2, mean RBT: 4859 cc. Most fractures were C1 Tile. External fixation was used in 38 patients (63%) and 51 (85%) patients were treated initially by angio. We found active arterial bleeding in 48 cases. Successful embolization was achieved in 85%. Both treatments was used in 23 patients. Laparotomy was performed in 21 patients. Incidence of systemic complications was high. Mortality was 21 %.

Conclusions:

1. Arterial lesions demonstrated by arteriogram were high in our study.

2. External fixation for control hemodynamics it’s useful mainly in open book fra