Advertisement

European Journal of Trauma and Emergency Surgery

, Volume 44, Issue 5, pp 747–752 | Cite as

Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures

  • Uwe Schweigkofler
  • B. Wohlrath
  • H. Trentsch
  • J. Greipel
  • N. Tamimi
  • R. Hoffmann
  • D. Wincheringer
Original Article

Abstract

Background

Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine.

Methods

We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures. Data were collected anonymously via a standardized case report.

Results

A total of 254 patients with suspected pelvic injuries from 12 different trauma centers were included in this study. In 95 out of 254 cases a per definition unstable pelvic fracture could be confirmed; 46 type B and 49 type C fractures was confirmed. Mechanical stability examination was carried out in 61% and revealed a sensitivity of 31.6% and a specificity of 92.2%. 11.5% (18 patients) actually showed a mechanical instability (6 B# 12 C#). Regardless, 166 patients (65.4%) received noninvasive external stabilization ahead of diagnostic imaging, as a result of clinical judgment. 72% (24×) showed signs of significant bleeding in the subsequent CT scans. 33 pelvic ring fractures (type B or C) had no prehospital stabilization.

Conclusion

Testing of mechanical stability of the pelvic ring was carried out less often and with lower consequences for the actual management than expected. It seems worthwhile to rather put on a pelvic binder at earliest occasion based on trauma mechanism or clinical findings to reduce the risk of serious pelvic bleeding.

Keywords

Pelvic ring fracture Pelvic binder Pelvic ring stabilization Prehospital management Emergency room treatment 

Notes

Compliance with ethical standards

Conflict of interest

All authors (Schweigkofler, Wohlrath, Trentzsch, Greipel, Tamimi, Hoffmann and Wincheringer) declare no conflict of interest.

References

  1. 1.
    Lefering R, Paffrath T. Sektion Notfall- Intensivmedzin und Schwerverletztenversorgung (NIS) der DGU: TraumaRegister DGU/TraumaRegisterQM DGU Jahresbericht 2012;2012.Google Scholar
  2. 2.
    Manson T, O’Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J. Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 2010;24:603–9.CrossRefGoogle Scholar
  3. 3.
    Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, Borer DS, Rao AV, Jones AL. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma. 2002;16:553–61.CrossRefGoogle Scholar
  4. 4.
    Bonner TJ, Eardley WG, Newell N, et al. Accurate placement of a pelvic binder improves reduction of unstable fractures in the pelvic ring. J Bone Jt Surg Br. 2011;93-B:1524–8.CrossRefGoogle Scholar
  5. 5.
    Spanjersberg WR, Knops SP, Schep NW, et al. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009;40:1031–5.CrossRefGoogle Scholar
  6. 6.
    Tan EC, van Stigt S, van Vugt A. Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury. 2010;41:1239–43.CrossRefGoogle Scholar
  7. 7.
    NAEMT, Herausgeber. Präklinisches Traumamanagement, Prehospital Trauma Life Support (PHTLS), 2. Aktualisierte und überarbeitete Auflage. Elsevier GmbH, Munich, 2012.Google Scholar
  8. 8.
    American College of Surgeons Committee on Trauma. Abdominal and pelvic trauma. In: American College of Surgeons, editor. ATLS student course manual. 9th ed. Chicago: American College of Surgeons; 2012. pp. 122–140.Google Scholar
  9. 9.
    Grant PT. The diagnosis of pelvic fractures by ‘springing’. Arch Emerg Med. 1990;7(3):178–82.CrossRefGoogle Scholar
  10. 10.
    Pehle B, Nast-Kolb D, Oberbeck R, et al. Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room. Unfallchirurg. 2003;106(8):642–8.CrossRefGoogle Scholar
  11. 11.
    Shlamovitz GZ, Mower WR, Bergman J, et al. How (un)useful is the pelvic ring stability examination in diagnosing mechanically unstable pelvic fractures in blunt trauma patients? J Trauma. 2009;66(3):815–20.CrossRefGoogle Scholar
  12. 12.
    Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF) (2016): S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. Deutsche Gesellschaft für Unfallchirurgie (Hrsg), AWMF-Register Nr. 012/019. http://www.awmf.org/leitlinien/detail/ll/012-019.html. Zugegriffen 29.06.2017.
  13. 13.
    McCormack R, Strauss EJ, Alwattar BJ, et al. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis. 2010;68:281–91.PubMedGoogle Scholar
  14. 14.
    Pohlemann T, Tscherne H, Baumgärtel F, et al. Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg. 1996;99:160–7.CrossRefGoogle Scholar
  15. 15.
    Siegmeth A, Müllner Th, Kukla Ch, et al: Begleitverletzungen beim schweren Beckentrauma. Unfallchirurg. 2000;103:572–81.CrossRefGoogle Scholar
  16. 16.
    Eastridge BJ, Starr A, Minei JP, et al. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–51.CrossRefGoogle Scholar
  17. 17.
    Smith WR, Moore EE, Osborn P, et al: Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representive cases and a description of technique. J Trauma 2005; 59:1510–1514.CrossRefGoogle Scholar
  18. 18.
    Fu CY, Wu SC, Chen RJ, et al. Evaluation of pelvic fractures stability and the need for angioembolisation: pelvic instabilities on plain film have an increased probability of requiring angioembolisation. Am J Emerg Med. 2009;27:792–6.CrossRefGoogle Scholar
  19. 19.
    Scalea T, O’Toole R. Pelvic fractures. In: Felicano D, Mattox K, Moore E, editors. Trauma. 6th ed. New York City: McGraw-Hill. 2008. p. 783 (Cap. 38).Google Scholar
  20. 20.
    Wohlrath B, Trentzsch H, Hoffmann R, et al. Präklinische und klinische Versorgung der instabilen Beckenverletzung-Ergebnisse einer Online-Umfrage; Unfallchirurg 2016, 119; pp. 755–62.CrossRefGoogle Scholar
  21. 21.
    Pohlemann T, Tscherne H, editors: Becken und Acetabulum. Tscherne Unfallchirurgie in 13 Bänden. Springer, Berlin, 1998Google Scholar
  22. 22.
    Deutsche Gesellschaft für Unfallchirurgie (DGU). Sektion Intensiv- & Notfallmedizin, Schwerverletztenversorgung (NIS) und AUC - Akademie der Unfallchirurgie GmbH, DGU Traumaregister Jahresbericht 2015. http://www.traumaregister-dgu.de/Downloads/TR-DGU-Jahresbericht_22.7.2017.
  23. 23.
    Schweigkofler U, Wohlrath B, Paffrath T, et al. Recommendations for releasing the pelvic binder after a non-invasive pelvic stabilisation procedure under emergency room conditions. Z Orthop Unfall. 2016;154(5):470–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Uwe Schweigkofler
    • 1
  • B. Wohlrath
    • 1
  • H. Trentsch
    • 2
  • J. Greipel
    • 3
  • N. Tamimi
    • 1
  • R. Hoffmann
    • 1
  • D. Wincheringer
    • 1
  1. 1.Abt. für Orthopädie & UnfallchirurgieBerufsgenossenschaftliche Unfallklinik FrankfurtFrankfurtGermany
  2. 2.Institut für Notfallmedizin und MedizinmanagementMunichGermany
  3. 3.Abt. für Orthopädie & UnfallchirurgieBerufsgenossenschaftliche Unfallklinik MurnauMurnauGermany

Personalised recommendations