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:

Arterial lesions demonstrated by arteriogram were high in our study.

Background and Objectives: Damage control orthopaedics (DCO) seeks to minimize surgical impact while treating all long bone and pelvic fractures in an emergency basis. Temporary external fixation is the preferred method for DCO in polytrauma care and mass casualty events.. External fixation allows stabilisation of long bone fractures without prolonged surgical procedures; reduce blood loss and systemic inflammatory response, although it is not clear which is the effect on complications and mortality.

Materials and Methods: Case series. Retrospective analysis of data trauma registry data. We studied the clinical outcome of a consecutive group of by DCO concepts for long bone and pelvic fractures, including a mass casualty event with multiple victims from a bomb attack. We analyzed the clinical outcomes in terms of systemic complications and mortality measured by TRISS methodology.

Inclusion criteria: Age > 15, ISS> 16, external fixation in first 6 hours for long bone or pelvic fractures

Results: Between 2003 and 2008 45 patients met the inclusion criteria. Average age was 33 yrs, means ISS 35, and most patients suffered road traffic accidents. We performed 65 temporary external fixators in forty five patients. Most frequent procedures were femur external fixation in 30 cases followed by tibia external fixation in 25 patients. Systemic complication rate was high. Six patients died. We found a reduction in mortality between probability of survival by TRISS and real mortality of 0.18 (0, 67 Ps versus 0, 85 real survival)

Conclusions: External fixation for early fixation of long bone fractures in polytrauma patient is a safe and successful treatment. DCO seems to reduce mortality in severe polytrauma patients with multiple fractures.