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Operative Techniques and Recent Advances in Acute Care and Emergency Surgery pp 261–271Cite as

Modern Strategies for the Management of High-Energy Pelvic Fractures in the Twenty-First Century

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Abstract

High-energy pelvic fractures continue to represent a major challenge in trauma management due to the high rates of post-injury mortality of around 30–40% in the modern peer-reviewed literature. The main root cause of potentially preventable mortality relates to the delayed recognition of the extent of retroperitoneal hemorrhage and post-injury coagulopathy. Current management strategies for pelvic ring disruptions with associated hemorrhagic shock include resuscitative endovascular balloon occlusion of the aorta (REBOA) for patients “in extremis” in conjunction with point-of-care guided resuscitation for post-injury coagulopathy. There is increasing international consensus regarding the benefits of early pelvic external fixation in conjunction with direct preperitoneal pelvic packing (PPP), and subsequent angioembolization in patients with ongoing hemorrhage results in significantly improved survival from exsanguinating retroperitoneal hemorrhage. Modern classification systems provide guidance for grading of injury mechanisms and risk stratification of patients with hemodynamically unstable pelvic ring injuries in order to support protocol-driven acute resuscitation strategies and improved outcomes in this highly vulnerable patient cohort.

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Author information

Authors and Affiliations

  1. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

  2. Department of Surgery, University of Colorado, School of Medicine, Denver Health Medical Center, Denver, CO, USA

    Ernest E. Moore

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  1. Philip F. Stahel
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  2. Ernest E. Moore
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Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Milano, Italy

    Paolo Aseni

  2. School of Medicine, University of Milano-Bicocca, Niguarda Hospital, Milan, Milano, Italy

    Luciano De Carlis

  3. Department of Cardiac Surgery, IRCCS MultiMedica, Milan, Milano, Italy

    Alessandro Mazzola

  4. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Antonino M. Grande

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Stahel, P.F., Moore, E.E. (2019). Modern Strategies for the Management of High-Energy Pelvic Fractures in the Twenty-First Century. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_18

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  • DOI: https://doi.org/10.1007/978-3-319-95114-0_18

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95113-3

  • Online ISBN: 978-3-319-95114-0

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