[Severe pelvic injury with pelvic mass hemorrhage: determining severity of hemorrhage and clinical experience with emergency stabilization].
The blood loss during the acute period after complex pelvic trauma is finally responsible for the high mortality associated with this specific type of injury. Several protocols have been published for optimized management, but up to now comparable data are not available as no exact definitions exist judging the severity of trauma and blood loss. As part of a prospective study 19 patients after unstable pelvic injuries with unstable circulation underwent emergency stabilization by the pelvic C-clamp. Beside standard clinical parameter the initial hemoglobin value was converted into a "blood volume equivalent". 18 of the 19 patients had an injury severity according to group III and IV of the Hannover Polytrauma Score (PTS). Concommitant abdominal injuries were seen in 12 cases (23 injuries), concommitant urological injuries in 12 cases (14 injuries). In 13 cases the pelvis was the major source of bleeding in 9 cases an additional intraabdominal hemorrhage was observed. 11 patients died due to sequelae of their injury, 8 patients survived. Although the initial blood loss was comparable both in the group of the deceased patients and the survivors, a 44% higher subsequent blood substitution (= 10089 ml) was observed in the nonsurvivor group. In conclusion the data proofed that early control of hemorrhage is fundamental for the prognoses after complex pelvic trauma. The estimation of the blood loss may help in indicating aggressive emergency procedures like emergency stabilisation, pelvic clamps, surgical exploration and tamponade. This calculation may be a basis for a more detailed analyses of this devastating injury and judging the benefit of different management protocols.
Pohlemann
T
T
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Culemann
U
U
Gänsslen
A
A
Tscherne
H
H
D016063:Blood Loss, Surgical / Q000503:physiopathology; D001810:Blood Volume / Q000502:physiology; D001860:Bone Plates; D004630:Emergencies; D017707:Erythrocyte Transfusion; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006465:Hemoperitoneum / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006488:Hemostasis, Surgical; D006801:Humans; D007083:Iliac Artery / Q000293:injuries / Q000601:surgery; D009104:Multiple Trauma / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate