title: Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment.
abstract: OBJECTIVE
  Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP) is based on direct compression and control of both venous and arterial retroperitoneal bleeders. This study describes the safety and efficacy of emergent EPPP employment, as a stand-alone surgical treatment, that is, carried out without external pelvic fixation or emergent angiography.
  
  
  METHODS
  A retrospective chart review of all hemodynamic unstable, multi-trauma patients with mechanically unstable pelvic fractures treated by the EPPP technique at our medical center between the years 2005 and 2011. Survival rates, clinical, and physiological outcomes were followed prospectively.
  
  
  RESULTS
  Twenty-five of the 181 pelvic fracture patients had biomechanically unstable fractures that required surgical fixation. Fourteen of those 25 patients had deteriorating hemodynamic instability from massive pelvic bleeding which was resistant to resuscitation, and they underwent EPPP, as a stand-alone treatment. The procedure successfully achieved hemodynamic stability in all 14 patients and obviated the early mortality associated with massive pelvic bleeding. Three of these patients eventually succumbed to their multiple injuries.
  
  
  CONCLUSIONS
  Implementation of EPPP improved all measured physiological outcome parameters and survival rates of hemodynamically unstable multi-trauma patients with unstable pelvic fractures in our trauma center. It provided the unique advantage of directly compressing the life-threatening retroperitoneal bleeders by applying direct pressure and causing a tamponade effect to stanch venous and arterial pelvic blood flow and obviate the early mortality associated with massive pelvic bleeding.
authors.affiliation: Department of Orthopaedic Surgery, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Ron
authors.affiliation: Department of Orthopaedic Surgery, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Epstein
authors.affiliation: Department of Orthopaedic Surgery, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Peleg
authors.initials: P
authors.lastname: Ben-Galim
authors.affiliation: Trauma Unit, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Klein
authors.affiliation: Department of Orthopaedic Surgery, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaban
authors.affiliation: Department of Orthopaedic Surgery, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Shaul
authors.initials: S
authors.lastname: Sagiv
keywords: Extra-peritoneal packing; hemodynamic instability; multi-trauma; pelvic fractures; salvage procedure