Arterial embolization for trauma patients with pelvic fractures in emergency settings: A nationwide matched cohort study in Japan

Future directions in the treatment of pelvic fractures with abdominal organ injury: the potential of combined endovascular embolization and external fixation techniques

Pelvic fractures with abdominal organ injuries are complex and life-threatening conditions that pose significant challenges in trauma care. Current management strategies, including external fixation and interventional radiology techniques such as embolization, have shown promise in stabilizing the pelvis and controlling hemorrhage. However, these approaches face challenges such as the lack of standardized protocols, variability in patient selection, and the need for robust multidisciplinary collaboration. Additionally, the combined use of these modalities may lead to improved outcomes, including reduced mortality and shorter hospital stays, but further research is needed to optimize their application. This review aims to comprehensively explore the potential synergies between endovascular embolization and external fixation in managing these complex injuries. It critically assesses the latest clinical evidence, identifies gaps in current practices, and proposes future directions to enhance treatment effectiveness and patient outcomes.

Hemostatic Interventions and All-Cause Mortality in Hemodynamically Unstable Pelvic Fractures: A Systematic Review and Meta-Analysis

Objective

To conduct a systematic review and meta-analysis of the all-cause mortality associated with the most commonly used hemostatic treatments in patients with hemodynamically unstable pelvic fractures.

Methods

Up to April 30, 2023, we searched PubMed, Embase, Web of Science, and Cochrane, including the references to qualified papers. A meta-analysis was performed on studies that reported odds ratios (ORs) or the number of events needed to calculate them. The PROSPERO registration number was CRD42023421137.

Results

Of the 3452 titles identified in our original search, 29 met our criteria. Extraperitoneal packing (EPP) (OR = 0.626 and 95% CI = 0.413-0.949), external fixation (EF) (OR = 0.649 and 95% CI = 0.518-0.814), and arterial embolism (AE) (OR = 0.459 and 95% CI = 0.291-0.724) were associated with decreased mortality. Resuscitative endovascular balloon occlusion of the aorta (REBOA) (OR = 2.824 and 95% CI = 1.594-5.005) was associated with increased mortality. A random effect model meta-analysis of eight articles showed no difference in mortality between patients with AE and patients with EPP for the initial treatments for controlling blood loss (OR = 0.910 and 95% CI = 0.623-1.328).

Conclusion

This meta-analysis collectively suggested EF, AE, or EPP as life-saving procedures for patients with hemodynamically unstable pelvic fractures.