title: Management of Acute Hemorrhage in Pelvic Trauma: An Overview.
abstract: Pelvic disruption is a combination of fractures or dislocations of the pelvic ring with trauma of the soft tissues on the inside and outside of this ring. Hemodynamic instability is the result of blood loss out of the fracture fragments, the posterior venous plexus, ruptured pelvic organs, or arterial lesions. In the resuscitation phase, different measures are possible to reduce the volume of the disrupted pelvis and to restore mechanical stability. They are not competitive but complementary. Pelvic binders should be used in the prehospital phase before and during transport. Application of a pelvic C-clamp is restricted to inhospital patients with C-type pelvic ring lesions and with severe and ongoing hemodynamic instability. External fixation is most useful in B-type but also has limited value in C-type injuries. The prerequisite for pelvic packing is the restoration of mechanical stability by pelvic C-clamping or external fixation. It is effective in severe venous bleeding in the small pelvis. Pelvic angiography and selective embolization is performed in patients with active arterial bleeding. These patients can be identified by a convincing clinical picture, by early multislice computed tomography (CT) with contrast- enhanced angiographic technique, or by the persistent need for volume replacement after C-clamping, external fixation, or pelvic packing.
authors.affiliation: Center for Musculoskeletal Surgery, University Medical Center,Johannes Gutenberg-University, Mainz, Germany. pol.rommens@unimedizin-mainz.de.|Center for Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany. pol.rommens@unimedizin-mainz.de.
authors.forename: Pol M
authors.initials: PM
authors.lastname: Rommens
authors.affiliation: Center for Musculoskeletal Surgery, University Medical Center,Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hofmann
authors.affiliation: Department of Orthopedic and Trauma Surgery, Academic Hospital Fulda, Fulda, Germany.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Hessmann
keywords: Hemorrhagic shock; Management of acute hemorrhage in pelvic trauma; Management of skeletal injuries in polytrauma; Multiple trauma; Pelvic fractures; Pelvic hemorrhage; Pelvis
references.citation: Injury. 2009 Nov;40 Suppl 4:S53-61
references.pmid: 19895954
references.citation: Radiol Med. 2010 Jun;115(4):648-67
references.pmid: 20082229
references.citation: J Trauma. 2005 May;58(5):985-90
references.pmid: 15920413
references.citation: J Trauma. 2002 Jan;52(1):158-61
references.pmid: 11791068
references.citation: Unfallchirurg. 2008 Oct;111(10):821-8
references.pmid: 18622589
references.citation: J Trauma. 2005 May;58(5):978-84; discussion 984
references.pmid: 15920412
references.citation: Surgery. 1973 Mar;73(3):454-62
references.pmid: 4687804
references.citation: Injury. 1996;27 Suppl 2:B3-19
references.pmid: 8915198
references.citation: Curr Opin Crit Care. 2003 Dec;9(6):515-23
references.pmid: 14639072
references.citation: Oper Orthop Traumatol. 2005 Sep;17(3):296-312
references.pmid: 16132252
references.citation: J Orthop Trauma. 2001 Sep-Oct;15(7):468-74
references.pmid: 11602828
references.citation: J Trauma. 2002 Aug;53(2):303-8; discussion 308
references.pmid: 12169938
references.citation: Injury. 1975 Aug;7(1):53-6
references.pmid: 1205596
references.citation: Unfallchirurg. 2004 Dec;107(12 ):1185-91
references.pmid: 15565386
references.citation: Injury. 2007 Jan;38(1):118-21
references.pmid: 16765956
references.citation: J Trauma. 1997 Sep;43(3):395-9
references.pmid: 9314298
references.citation: Clin Orthop Relat Res. 1999 Apr;(361):237-44
references.pmid: 10212618
references.citation: J Bone Joint Surg Am. 2002;84-A Suppl 2:43-7
references.pmid: 12479338
references.citation: Injury. 2006 Jul;37(7):602-13
references.pmid: 16309680
references.citation: Clin Orthop Relat Res. 1989 Apr;(241):66-82
references.pmid: 2647337
references.citation: Unfallchirurg. 2000 Jul;103(7):572-81
references.pmid: 10969545
references.citation: Clin Orthop Relat Res. 1991 Jun;(267):71-8
references.pmid: 2044295
references.citation: Acta Chir Belg. 1996 Apr;96(2):78-84
references.pmid: 8686407
references.citation: Scand J Trauma Resusc Emerg Med. 2009 Nov 29;17 :62
references.pmid: 19943960
references.citation: Unfallchirurg. 1992 Apr;95(4):189-96
references.pmid: 1636100
references.citation: Injury. 2007 Jan;38(1):125-8
references.pmid: 16996515
references.citation: J Orthop Trauma. 2002 Feb;16(2):92-8
references.pmid: 11818803
references.citation: J Trauma. 2004 Aug;57(2):271-6; discussion 276-7
references.pmid: 15345972
references.citation: Crit Care. 2007;11(1):204
references.pmid: 17300738
references.citation: Acta Orthop Belg. 1993;59(2):130-8
references.pmid: 8372647
references.citation: J Trauma. 2007 Apr;62(4):843-52
references.pmid: 17426538
references.citation: Injury. 2005 Jan;36(1):1-13
references.pmid: 15589906
references.citation: J Bone Joint Surg Br. 1988 Jan;70(1):1-12
references.pmid: 3276697
references.citation: Radiology. 1986 Aug;160(2):445-51
references.pmid: 3726125
references.citation: Orthop Clin North Am. 1997 Jul;28(3):345-50
references.pmid: 9208828
references.citation: J Trauma. 1998 Mar;44(3):454-9
references.pmid: 9529171
references.citation: Acta Chir Belg. 1997 Apr;97(2):65-8
references.pmid: 9161586
references.citation: Orthopade. 1998 Jan;27(1):32-44
references.pmid: 9540100
references.citation: J Trauma. 1990 Jul;30(7):848-56
references.pmid: 2381002
references.citation: Injury. 1996;27 Suppl 1:S-A21-3
references.pmid: 8762339
references.citation: Injury. 1996;27 Suppl 1:S-A38-45
references.pmid: 8762342
references.citation: Acta Chir Belg. 2006 Sep-Oct;106(5):500-7
references.pmid: 17168258
references.citation: J Orthop Trauma. 1999 Mar-Apr;13(3):207-11
references.pmid: 10206253
references.citation: Injury. 2009 Apr;40(4):343-53
references.pmid: 19278678
references.citation: J Trauma. 2005 Sep;59(3):659-64
references.pmid: 16361909
references.citation: Injury. 1998 Apr;29(3):187-91
references.pmid: 9709419
references.citation: Orthopade. 2006 Dec;35(12 ):1225-36
references.pmid: 17106743
references.citation: Unfallchirurg. 1994 Oct;97(10):503-10
references.pmid: 7809636
references.citation: Injury. 2009 Oct;40(10):1023-30
references.pmid: 19371871
references.citation: J Trauma. 2007 Apr;62(4):834-9; discussion 839-42
references.pmid: 17426537
references.citation: J Trauma. 1989 Jul;29(7):981-1000; discussion 1000-2
references.pmid: 2746708
references.citation: J Trauma. 2003 Mar;54(3):437-43
references.pmid: 12634521
references.citation: Clin Orthop Relat Res. 1995 Jan;(310):245-51
references.pmid: 7641446