title: Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy.
abstract: Exsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy. This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation.
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mauffrey
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: D O
authors.initials: DO
authors.lastname: Cuellar
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: F
authors.initials: F
authors.lastname: Pieracci
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Hak
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Hammerberg
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: Stahel
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Burlew
authors.affiliation: Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Moore
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D012151:Resuscitation / Q000379:methods; D013916:Thrombelastography
keywords: Angio-embolisation; Bleeding pelvic fractures; Haemodynamic instability; Massive transfusion protocol; Pelvic fracture; Pelvic packing; TIC; Trauma-induced coagulopathy