Exsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy.

This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation.

Cite this article: Bone Joint J 2014; 96-B:1143–54.

Purpose: The purpose of the study is to access the efficacy of CT angiogram evaluation of the vertebral artery in patients with blunt cervical trauma. Our hypothesis was that there was no protocal for evaluation or treatment of vertebral artery injuries, and that patients with proven vertebral artery injury were not being treated and patients at risk were not being evaluated. An appropriate protocal was established.

Method: 721consequtive patients with blunt cervical spine injuries were reviewed for cervical injury at risk for vertebral artery injury (C1–C3 fractures, fractures through transverse foreman, and significant subluxationor dislocation of the cervical spine), subsequent CT angiograms done to evaluate possible vertebral artery injury, treatment and clinical course

Results: 271 patients met criteria for possible vertebral artery injury. 156 had CT angiograms, of which 19 were positive for vertebral artery injury. 12 of the 19 patients with positive CT angiograms for vertebral artery injury were not treated with antithrombotic therapy because of associated injuries. An additional 115 patients had cervical spine injuries at risk for vertebral artry injury and did not have a CT angiogram done. There were 3 patients who had CVA’s, one patient who had a positive CT angiogram for Vertebral artery injury and 2 patients at risk and not evaluated.

Conclusion:

Patients with blunt cervical trauma are at risk for vertebral artery injury, which can result in significant neurological sequalae