Summary:
Massive hemorrhage associated with displaced pelvic fractures is one of the most serious emergencies faced by orthopaedic and trauma surgeons. Postmortem angiography and studies performed by Huittinen and Slatis and angiography studies on pelvic fracture patients in a number of institutions indicate that the source of bleeding in 90% of these injuries is the pelvic veins and fracture surfaces. Despite the fact that these are low-pressure systems, large volumes of blood can collect in the extraperitoneal and retroperitoneal space over a period of several hours. Uncontrolled hemorrhage is often complicated by hypothermia and coagulopathy, which lead to profound shock and death within hours of admission to the hospital. Because of the geometry of the pelvis, a few centimeters of displacement can lead to a doubling of the potential intrapelvic volume for hematoma formation. Movement of the unstable hemipelvis during the initial period of physical examination, resuscitation, and radiographic studies will interfere with clot formation and aggravate the bleeding. To overcome these problems, the displaced pelvis must be reduced and stabilized immediately after the pelvic ring disruption is identified. The pneumatic antishock garment (MAST trousers) has been used effectively for this purpose. This device limits access to the abdomen and perineum and can cause compartment syndrome, particularly in hypotensive patients. External fixation is an excellent method to achieve reduction and provisional stabilization of the displaced pelvic ring. Because of the equipment requirements, an external fixator is most frequently applied in the operating room. The procedure is often delayed until after the completion of resuscitation, radiographic evaluation, and head, chest, and abdominal surgery. Internal fixation, which is appropriate for some fracture patients, also must be delayed until other index surgery is completed. Recognizing the difficulties in using the Pneumatic Antishock Garment, external fixation, and internal fixation, the Pelvic Stabilizer has been developed as a new method to provide emergent reduction and stabilization of pelvic ring disruption with associated hemorrhage. This device was designed to be applied in the emergency room with a local anesthetic. It can be affixed to the patient rapidly and easily as soon as the displaced pelvic ring disruption is identified. Its design and position of application allow unobstructed access to the abdomen and perineum for subsequent radiographic studies and surgical procedures. Initial results show its effectiveness in reduction and stabilization of the pelvic ring, in maintenance of the reduction, and in achieving patient hemodynamic stability. Finally, this new device may help identify the few patents who have arterial, in addition to venous, hemorrhage in the pelvis.
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