title: The role of angio-embolization in the acute treatment concept of severe pelvic ring injuries.
abstract: BACKGROUND
  In recent years a wide variety of strategies to treat the haemodynamically unstable patient with pelvic ring fractures have been proposed. This study evaluates our institutional management of patients with severe pelvic fractures and analyses their outcomes.
  
  
  METHODS
  Retrospective review of all severely injured trauma patients with pelvic ring injuries admitted to a level I trauma centre from 2007 to 2012. Patient records were documented prospectively in a trauma database and evaluation was performed by SPSS.
  
  
  RESULTS
  During the study period, a total of 173 patients with pelvic ring fractures were admitted and formed the basis of this study. Overall, 46% of the patients had suffered a type A fracture, 25% a type B fracture and the remaining 29% a type C pelvic ring fracture. Surgical treatment was required in 21% of the patients (pelvic C-clamp, n = 6; supra-acetabular external fixator, n = 32; pelvic packing, n = 12; definitive plate osteosynthesis of the pubis symphysis, n = 6). Angio-embolization was performed in 16 patients (9%); in 8 patients it was the only specific treatment for the pelvic injury on day 0 and in 8 patients it was performed immediately post-operatively. The overall mortality rate was 12.7% (n = 22), with the type C pelvic fractures having the highest mortality (30.0%). Four patients died immediately after admission in the shock room.
  
  
  CONCLUSIONS
  Angiographic embolization as a first-line treatment was only performed in haemodynamically stable patients or in patients responding to fluid resuscitation with the finding of an arterial blush in the CT scan. In haemodynamically unstable patients, pre-peritoneal pelvic packing in combination with mechanical pelvic stabilization was immediately carried out, followed by angio-embolization post-operatively if signs of persistent bleeding remained present.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt am Main, Frankfurt, Germany. Electronic address: tom.lustenberg@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt am Main, Frankfurt, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt am Main, Frankfurt, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Störmann
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt am Main, Frankfurt, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Laurer
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt am Main, Frankfurt, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000792:Angiography / Q000379:methods / Q000401:mortality; D001860:Bone Plates; D002985:Clinical Protocols; D004621:Embolization, Therapeutic / Q000379:methods; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation; D050723:Fractures, Bone / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006439:Hemodynamics; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers
keywords: Fracture; Pelvic; angiography; embolization; management; mechanical pelvic stabilization