title: [Influence of external pelvic stabilization on hemodynamically unstable pelvic fractures].
abstract: BACKGROUND
  In the treatment of complex pelvic fractures hemorrhage control is of primary importance; however, studies regarding the localization of bleeding are contradictory so that various treatment approaches are recommended. The primary aim of external pelvic compression applied in the trauma room is to reduce the pelvic volume and counteract blood loss through self-induced tamponade. This study examined the influence of external pelvic compression on mortality and outcome in cases of hemodynamically unstable pelvic fractures in a larger number of cases.
  
  
  METHODS
  The current study used the TraumaRegister DGU® (TR-DGU) to retrospectively evaluate the records of 104 patients treated between 2002 and 2011. All patients suffered severe injury with an injury severity score (ISS) of at least 16 points. In addition, the patients were hemodynamically unstable with confirmed relevant isolated pelvic injuries. To evaluate the effectiveness of external pelvic compression, patients with and without external pelvic stabilization were compared.
  
  
  RESULTS
  Of the investigated patients 26.9 % died of their injuries and of these the mortality was 78.6 % within the first 6 h of admission to the trauma room. External pelvic stabilization was performed in 45.2 % of patients. The mortality was 19.1 % in patients with external pelvic stabilization and in contrast, the mortality in the group of patients without external pelvic stabilization was 33.3 %. During the course of hospitalization, surviving patients with external pelvic stabilization were significantly more likely to develop sepsis or multiple organ failure and required longer periods of intensive care.
  
  
  CONCLUSIONS
  External pelvic stabilization seems to be an important instrument for the initial treatment of hemodynamically unstable pelvic fractures and showed a positive effect on patient mortality.
authors.affiliation: Orthopädie und Unfallchirurgie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland. Emrahesmer@gmx.de.
authors.forename: E
authors.initials: E
authors.lastname: Esmer
authors.affiliation: Orthopädie und Unfallchirurgie, Johanniter-Krankenhaus Geesthacht, Geesthacht, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Esmer
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Halle, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Derst
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Halle, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Schulz
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Halle, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Siekmann
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Halle, Deutschland.
authors.forename: K S
authors.initials: KS
authors.lastname: Delank
mesh_terms: D000328:Adult; D015984:Causality; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000401:mortality* / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006470:Hemorrhage / Q000401:mortality* / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Hemodynamic instability; Pelvic C-clamp; Pelvic fracture; Trauma room treatment; TraumaRegister DGU®