Imaging comparison of pelvic ring disruption and injury reduction with use of the junctional emergency treatment tool for preinjury and postinjury pelvic dimensions: a cadaveric study with computed tomography.
OBJECTIVE
Complex dismounted blast injuries from (improvised) explosive devices have caused amputations of the lower extremities associated with open injuries to the pelvic ring, resulting in life-threatening hemorrhage from disruption of blood vessels near the pelvic ring. Provisional stabilization of the skeletal pelvis by circumferential pelvic compression provides stability for intrapelvic clots and reduces the volume of the pelvis, thereby limiting the amount of hemorrhage. The Junctional Emergency Treatment Tool (JETTtm; North American Rescue Products, http://www.narescue.com) is a junctional hemorrhage control device developed to treat pelvic and lower extremity injuries sustained in high-energy trauma on the battlefield and in the civilian environment. Our purpose was to evaluate the compressive function of the JETT in the reduction of pelvic ring injuries in a cadaveric model.


METHODS
Radiographic comparison of pre (intact) and post pelvic ring disruption and injury was compared with radiographic measurements post reduction with the JETT device in two cadavers. The device's ability to reduce pelvic disruption and injury in a human cadaver model was assessed through measurements of the anteroposterior (AP) and transverse diameters obtained at the inlet and outlet of the pelvis.


RESULTS
Computed tomography (CT) scans demonstrated that JETT application effectively induced circumferential soft tissue compression that was evoked near anatomic reduction of the sacroiliac joint and symphysis pubis.


CONCLUSIONS
The JETT is capable of effectively reducing an AP compression type III injury (APC III) pelvic ring disruption and injury by approximating the inlet and outlet dimensions toward predisruption measurements. Such a degree of reduction suggests that the JETT device may be suitable in the acute setting for provisional pelvic stabilization.
Joshua L
JL
Gary
Manickam
M
Kumaravel
Keith
K
Gates
Andrew R
AR
Burgess
Milton L
ML
Routt
Timothy
T
Welch
Jeanette M
JM
Podbielski
Angela M
AM
Beeler
John B
JB
Holcomb
D001753:Blast Injuries; D002102:Cadaver; D004638:Emergency Treatment / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006119:Groin; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008953:Models, Anatomic; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014111:Tourniquets