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Pelvic Fractures and Indications for Pelvic Packing: An Update

  • Nicole L. Werner
  • Clay Cothren BurlewEmail author
Trauma Surgery (J. Diaz, Section Editor)
  • 15 Downloads
Part of the following topical collections:
  1. Trauma Surgery

Abstract

Purpose of review

Patients with hemodynamically unstable pelvic fractures have a high mortality from pelvic hemorrhage. The purpose of this paper is to review preperitoneal pelvic packing (PPP) as an approach for these patients, including recent outcomes, and evaluation of treatment algorithms including angioembolization and resuscitative endovascular balloon occlusion of the aorta (REBOA).

Recent findings

There are no randomized clinical trials comparing PPP to other methods for controlling pelvic hemorrhage. The largest retrospective series, reporting on 128 patients, had a mortality rate of 21% and showed a reduction of blood transfusions after external fixation and PPP; smaller series and a meta-analysis also demonstrate similar results.

Summary

PPP with external pelvic fixation should be adopted as the first-line intervention for patients with pelvic fractures who remain hemodynamically unstable despite blood transfusion. It takes a lesser time to achieve hemorrhage control than angioembolization and directly addresses the primary source of pelvic fracture-related bleeding.

Keywords

Pelvic fracture Pelvic packing Preperitoneal pelvic packing Trauma Hemorrhage 

Notes

Compliance with Ethical Guidelines

Conflict of interest

Nicole L. Werner and Clay Cothren Burlew declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The article contains a retrospective evaluation of human patients performed by the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Ernest E. Moore Shock Trauma Center, Denver Health Medical CenterUniversity of Colorado School of MedicineDenverUSA

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