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Stahel PF, Ziran N. The pathophysiology of pelvic ring injuries: a review. Patient Saf Surg 2024; 18:16. [PMID: 38741186 DOI: 10.1186/s13037-024-00396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
Traumatic pelvic ring injuries continue to represent a major challenge due to the high rates of post-injury mortality of around 30-40% in the peer-reviewed literature. The main root cause of potentially preventable mortality relates to the delayed recognition of the extent of retroperitoneal hemorrhage and post-injury coagulopathy. The understanding of the underlying pathophysiology of pelvic trauma is predicated by classification systems for grading of injury mechanism and risk stratification for developing post-injury coagulopathy with subsequent uncontrolled exsanguinating hemorrhage. This review article elaborates on the current understanding of the pathophysiology of severe pelvic trauma with a focus on the underlying mechanisms of retroperitoneal bleeding and associated adverse outcomes.
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Affiliation(s)
- Philip F Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, 27834, Greenville, NC, USA.
- Rocky Vista University, College of Osteopathic Medicine, 80134, Parker, CO, USA.
- Mission Health, HCA Healthcare, North Carolina Division, 28803, Asheville, NC, USA.
| | - Navid Ziran
- St. Joseph's Hospital and Medical Center, 85020, Phoenix, AZ, USA
- North Bay Medical Center, 94534, Fairfield, CA, USA
- Satori Orthopaedics, Inc, 85020, Phoenix, AZ, USA
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Xu D, Liu M, Lou W, Li M, Xiao J, Wu H, Zhuang Y, Chen J. Hidden blood loss and the influential factors after minimally invasive treatment of posterior pelvic ring injury with sacroiliac screw. Trials 2024; 25:305. [PMID: 38711052 DOI: 10.1186/s13063-024-08147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND To analyze the perioperative bleeding and hidden blood loss (HBL) of sacroiliac screw minimally invasive treatment of pelvic posterior ring injury and explore the influential factors of HBL after operation for providing reference for clinical treatment. METHOD A retrospective analysis was conducted on data from 369 patients with posterior pelvic ring injuries treated with sacroiliac screws internal fixation at our hospital from January 2015 to January 2022. The research was registered in the Chinese Clinical Trial Registry in July 2022 (ChiCTR2200061866). The total blood loss (TBL) and HBL of patients were counted, and the factors such as gender, age, and surgical duration were statistically analyzed. The influential factors of HBL were analyzed by multiple linear regression. RESULTS The TBL was 417.96 ± 98.05 ml, of which the visible blood loss (VBL) was 37.00 ± 9.0 ml and the HBL was 380.96 ± 68.8 ml. The HBL accounted for 91.14 ± 7.36% of the TBL. Gender, surgical duration, fixed position, and fixed depth had significant effects on the HBL (P < 0.05). CONCLUSIONS The HBL was the main cause of anemia after minimally invasive treatment of posterior pelvic ring injury with a sacroiliac screw. Gender, surgical duration, fixed position, and fixed depth were closely related to the occurrence of HBL. In clinical treatment, we should consider these influential factors and take effective measures to reduce the impact of HBL on patients.
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Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China.
- Ningbo University Medical College, Ningbo, 315211, China.
| | - Min Liu
- Department of Orthopedics, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weigang Lou
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China
| | - Ming Li
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China
| | - Jingwei Xiao
- Ningbo University Medical College, Ningbo, 315211, China
| | - Hongbao Wu
- Ningbo University Medical College, Ningbo, 315211, China
| | - Yunqiang Zhuang
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China.
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, 1059 East Zhongshan Road, Ningbo, China.
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Collins AP, Abdelfattah W, Dasari SP, Unno F, Firoozabadi R, Kleweno CP, Psutka SP, Lack WD. Stable Lateral Compression Pelvic Ring Injury Requiring Operative Treatment due to Bladder Impingement: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00037. [PMID: 38788049 DOI: 10.2106/jbjs.cc.24.00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
CASE A 25-year-old man sustained a stable lateral compression Type I (LC I) pelvic ring injury upon missing the landing of a downhill ski jump. He presented with painful voiding from a displaced bony fragment, partially impaling the bladder wall. With operative fixation of the fracture and urologic co-management, the patient had excellent outcomes at 1-year follow-up. CONCLUSION We describe a rare urologic injury in the setting of an LC I pelvic ring injury. In the setting of an otherwise stable pelvic ring injury, careful review of imaging, detailed clinical history, and physical examination remain critical to optimizing patient outcomes.
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Affiliation(s)
- Andrew P Collins
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Suhas P Dasari
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Florence Unno
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Reza Firoozabadi
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Conor P Kleweno
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, Washington
| | - William D Lack
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
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Kim YJ, Scott BL, Pieracci FM, Moore EE, Mauffrey C, Parry JA. Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate. J Orthop Trauma 2023; 37:547-552. [PMID: 37828686 DOI: 10.1097/bot.0000000000002662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To evaluate the incidence of pelvic space surgical site infection (SSI) after preperitoneal pelvic packing (PPP) for persistent hemodynamic instability. DESIGN Retrospective comparative study. SETTING Urban Level 1 trauma center. PATIENTS/PARTICIPANTS 83 patients who received PPP and 55 patients who had open reduction and internal fixation (ORIF) of the anterior pelvic ring without PPP. INTERVENTION Operative fixation. MAIN OUTCOME MEASUREMENTS Pelvic space SSI. RESULTS The SSI rate in the PPP group was 31.3% (26/83) compared with 10.9% (6/55) in the control group (proportional difference 20.4%, confidence interval (CI) 6.4-32.5, P = 0.007). Patients in the PPP group (n = 43) were 1:1 propensity score matched with patients in the control group to account for differences in Injury Severity Score and American Society of Anesthesiologists score. In this matched cohort, the rate of pelvic space SSI remained higher in the PPP group compared with that in the control group (30.2% vs. 9.3%; proportional difference 20.9%, CI, 3.7-36.3; P = 0.02). On multivariate analysis of the PPP group, anterior ORIF (odds ratio 6.56, CI, 2.00-21.47, P = 0.002) was found to be independently associated with SSI. CONCLUSIONS PPP is an independent risk factor of space SSI. The likelihood of SSI after PPP is increased with anterior ORIF. The morbidity of SSI after PPP must be weighed against the risk of exsanguination. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Fredric M Pieracci
- Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO
| | - Ernest E Moore
- Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO
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DuBose JJ, Burlew CC, Joseph B, Keville M, Harfouche M, Morrison J, Fox CJ, Mooney J, O'Toole R, Slobogean G, Marchand LS, Demetriades D, Werner NL, Benjamin E, Costantini T. Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control. J Trauma Acute Care Surg 2021; 91:e93-e103. [PMID: 34238857 DOI: 10.1097/ta.0000000000003331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. In addition, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined. LEVEL OF EVIDENCE Review, level IV.
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Affiliation(s)
- Joseph J DuBose
- From the R Adams Cowley Shock Trauma Center (J.J.D., M.K., M.H., J.M., C.J.F., R.O., G.S.), University of Maryland Medical System, Baltimore, Maryland; Department of Surgery (C.C.B., N.L.W.), Denver Health Medical Center, Denver, Colorado; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (B.J.), College of Medicine, University of Arizona, Tucson, Arizona; Baylor University Medical Center (J.M.), Dallas, Texas; Department of Orthopedic Surgery (L.S.M.), University of Utah, Salt Lake City, Utah; Division of Trauma and Surgical Critical Care (D.D., E.B.), LAC+USC Medical Center, University of Southern California, Los Angeles, California; Trauma/Surgical Critical Care (T.C.), Grady Memorial Hospital/Emory University School of Medicine, Atlanta, Georgia; and Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (T.C.), University of California San Diego School of Medicine, San Diego, California
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Rodriguez-Fontan F, Maertens AS, Parry JA, Stacey S, Lauder A, Ipaktchi K, Heare A, Hadeed M, Mauffrey C. From Dr. Miller E. Preston (1879-1928) to the Department of Orthopaedics at Denver Health Medical Center in Denver, CO. INTERNATIONAL ORTHOPAEDICS 2021; 45:2997-3001. [PMID: 34328538 DOI: 10.1007/s00264-021-05132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
Dr. Miller Edwin Preston was a surgeon with a deep interest in trauma and orthopaedics who practiced in Denver in the early 1900s. Dr. Preston arrived in Denver shortly after the creation of Denver's first city hospital in 1860. This hospital would later be renamed to Denver General Hospital and then Denver Health Medical Center. It excels for the quality of its emergency medicine residency program, a very high survival rate for severely injured patients and the clinical pathways and algorithms pertinent to the management of haemodynamically unstable pelvic ring injuries among others. Today, Dr. Preston's legacy of excellence in the management of trauma patients is alive and well at Denver Health Medical Center, the city's only level-one safety net hospital and academic affiliate of the University of Colorado Medical School.
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Affiliation(s)
- Francisco Rodriguez-Fontan
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.,Department of Orthopaedics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew S Maertens
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.,Department of Orthopaedics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Stephen Stacey
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Alexander Lauder
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Kyros Ipaktchi
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Austin Heare
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Michael Hadeed
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
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