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Shen J, Ma H, Yang X, Hu M, Tian J. Perioperative impact of ultrasound-guided ilioinguinal and iliohypogastric nerve blocks in patients undergoing pelvic fracture surgery. Medicine (Baltimore) 2024; 103:e38634. [PMID: 38941385 DOI: 10.1097/md.0000000000038634] [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] [Indexed: 06/30/2024] Open
Abstract
Pelvic fractures present a severe and complex clinical challenge. This study aimed to compare ultrasound-guided ilioinguinal (IIN) and iliohypogastric nerve (IHN) blocks with conventional general anesthesia (GA) in patients undergoing internal fixation surgery for pelvic fractures. A retrospective analysis was conducted on 100 patients equally divided into ultrasound-guided and control groups. The study monitored hemodynamics, intraoperative anesthesia drug usage, postoperative pain levels, and the incidence of adverse reactions between the 2 groups. The ultrasound-guided group underwent ultrasound-guided IHN and IIN blocks combined with GA. The ultrasound-guided group exhibited significant advantages for hemodynamic measurements at specific time points, lower consumption of Propofol and Remifentanil, and reduced pain intensity across all evaluated time intervals (P < .05). The incidence rate of adverse reactions was significantly lower in the ultrasound group (P = .016). Ultrasound-guided anesthesia is a superior alternative to conventional GA for managing pelvic fractures through internal fixation surgery. It offers advantages in terms of hemodynamic stability, drug consumption, postoperative pain management, and adverse reaction reduction.
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Affiliation(s)
- Jie Shen
- Department of Anesthesiology, Handan First Hospital, Handan, Hebei Province, China
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Ye Z, Zong Z, Zhong X, Jia Y, Jiang R, Yang H, Zhou X, Du W. Characterization of Combined Blast- and Fragment-Induced Pelvic Injuries and Hemostatic Resuscitation in Rabbits. J Surg Res 2023; 285:158-167. [PMID: 36680876 DOI: 10.1016/j.jss.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/01/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To establish a blast- and fragment-induced pelvic injury animal model in rabbits, observe its injury characteristics, and explore the effects of hemostatic resuscitation combined with damage control surgery (DCS) with respect to this injury model. METHODS Forty-eight rabbits were randomly allocated to four groups: group A rabbits were subjected to pelvic injury, group B rabbits to pelvic injury + DCS, group C rabbits to pelvic injury + DCS + resuscitation with Hextend, and group D rabbits to pelvic injury + DCS + Hextend + hemostatic resuscitation with tranexamic acid, fibrinogen concentrate, and prothrombin complex concentrate. Simulated blast and fragment-induced pelvic injury was produced by a custom-made machine. We implemented CT scanning and necropsy to assess the injury state and calculated the coefficient of variation (CV) of the cumulative abbreviated injury scale (AIS) to assess the reproducibility of the animal model. Immediately after instrumentation (0 h), and 1 h, 2 h, 4 h, and 8 h after injury, blood samples were taken for laboratory tests. RESULTS We found that severe pelvic injury was produced with an AIS CV value of 10.32%, and the rabbits demonstrated severe physiologic impairment and coagulo-fibrinolytic derangements with high mortality. In rabbits of group D, however, physiologic and coagulo-fibrinolytic parameters were significantly enhanced with improved organ function and lowered mortality when compared with the other three groups. CONCLUSIONS We herein established in rabbits a blast- and fragment-induced pelvic injury animal model that exhibited high reproducibility, and we demonstrated that hemostatic resuscitation plus DCS was effective in improving the outcome.
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Affiliation(s)
- Zhao Ye
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care & Department of Orthopedics, XinQiao hospital, Army Medical University
| | - Zhaowen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care & Department of Orthopedics, XinQiao hospital, Army Medical University.
| | - Xin Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care, Army Medical University
| | - Yijun Jia
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care, Army Medical University
| | - Renqing Jiang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care, Army Medical University
| | - Haoyang Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care, Army Medical University
| | - Xiaolin Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care, Army Medical University
| | - Wenqiong Du
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for combat casualty care training, Training base for Army health care, Army Medical University
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Ferede B, Ayenew A, Belay W. Pelvic Fractures and Associated Injuries in Patients Admitted to and Treated at Emergency Department of Tibebe Ghion Specialized Hospital, Bahir Dar University, Ethiopia. Orthop Res Rev 2021; 13:73-80. [PMID: 34140815 PMCID: PMC8203598 DOI: 10.2147/orr.s311441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pelvic fractures are high-risk injuries that require careful evaluation due to significant patient morbidity and mortality associated with damage to major blood vessels, nerves, and organs. Thus, the aim of this study was to assess pelvic fractures and associated injuries among patients presented at the emergency department of Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Methods This is a cross-sectional study with a retrospective facility-based data collection technique. All patients who were managed for pelvic fracture from September 2018 to February 2021 were included. The patient’s chart number was collected from the orthopedics surgery morning register sheet and their case folders were retrieved from the medical record department. We used a structured and pretested checklist, and chart review for data collection. The collected data were cleaned, coded, and entered into Epi Info version 7 and exported to SPSS version 24 for analysis. Binary logistic regression analysis was used to identify factors associated with a pelvic fracture. Results We studied 64 cases of pelvic fracture during the study period. Pelvic was common among males with a ratio of 7:1 and young population (15–35 years). The most common associated injuries were lower extremity 23 (35.9%), abdominal injuries 16 (25.0%), and urethral injury in 13 (20.3%). Moreover, most patients with pelvic fracture have Tile A fracture 56.3%, Tile C in 20 (31.3%), and Tile B in 8 (12.5%) patients. The road traffic accident was the most common cause of pelvic fracture in 56.3%, followed by fall down accident (28.1%), and bullet injury (12.5%). Conclusion The incidence of pelvic fracture was high in the study area. It reflects the need for strong and multi-sectoral collaboration to prevent pelvic fracture. Additionally, it needs a careful, systematic management approach for survival, healing, and to address the associated complexities and the polytrauma nature.
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Affiliation(s)
- Biruk Ferede
- Department of Orthopedics and Traumatology, Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
| | - Asteray Ayenew
- Department of Midwifery, Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
| | - Worku Belay
- Department of Orthopedics and Traumatology, Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
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Bernhard Z, Myers D, Passias BJ, Taylor BC, Castaneda J. Testicular Dislocation After Unstable Pelvic Ring Injury. Cureus 2021; 13:e13119. [PMID: 33728137 PMCID: PMC7935200 DOI: 10.7759/cureus.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reproductive and genitourinary complications following pelvic ring injuries have been described; however, testicular dislocation is rare and can cause significant morbidity if not managed appropriately. We describe a case of testicular dislocation after pelvic ring injury and outline the subsequent management and outcome, and seek to identify areas of improvement to ensure expedient and appropriate care in the setting of these injuries. Our case describes a 29-year-old male who presented to a level-one trauma center following a motorcycle collision. An anteroposterior compression type II rotationally unstable pelvic ring was identified on imaging. He was hemodynamically unstable and computed tomography (CT) with angiography was ordered. Arterial extravasation was noted from the bilateral anterior internal iliac arteries, which were subsequently embolized by interventional radiology. However, no concomitant genitourinary injury was identified at the time of CT. After resuscitation, the pelvis was stabilized with an anterior symphyseal plate and bilateral sacroiliac screws. During the anterior pelvic approach, the patient’s dislocated testicle was surprisingly discovered inferior to the pubis. Urology was consulted intra-operatively, and the testicle was successfully relocated. At the final follow-up, the pelvic ring was healed without any noticeable urogenital complication. While testicular dislocation has been reported in the setting of pelvic ring injury, a paucity of information exists regarding management, implications, and areas for improvement in the identification of these injuries. Therefore, in cases of pelvic ring injury with significant trauma, radiologists, traumatologists, and orthopedic surgeons should adopt a multi-disciplinary approach in diligently attempting to rule out testicular dislocation pre-operatively. Intra-operatively, examination under anesthesia and careful operative technique are important in preventing iatrogenic injury.
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Affiliation(s)
- Zachary Bernhard
- Medical Education, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Devon Myers
- Orthopedic Surgery, OhioHealth, Columbus, USA
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Mejia D, Parra MW, Ordoñez CA, Padilla N, Caicedo Y, Pereira Warr S, Jurado-Muñoz PA, Torres M, Martínez A, Serna JJ, Rodríguez-Holguín F, Salcedo A, García A, Millán M, Pino LF, González Hadad A, Herrera MA, Moore EE. Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality. COLOMBIA MEDICA (CALI, COLOMBIA) 2020; 51:e4214510. [PMID: 33795905 PMCID: PMC7968423 DOI: 10.25100/cm.v51i4.4510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.
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Affiliation(s)
- David Mejia
- Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.,Universidad de Antioquia, Department of Surgery, Medellin, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Salin Pereira Warr
- Hospital Pablo Tobón Uribe, Grupo de Soporte Nutricional y Pared Abdominal, Medellin, Colombia
| | | | - Mauricio Torres
- Fundación Valle del Lili, Department of Orthopedic Surgery, Cali, Colombia
| | - Alfredo Martínez
- Fundación Valle del Lili, Department of Orthopedic Surgery, Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ernest E Moore
- University of Colorado, Denver Health Medical Center, Department of Surgery, Denver, CO USA
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Abdelrahman H, El-Menyar A, Keil H, Alhammoud A, Ghouri SI, Babikir E, Asim M, Muenzberg M, Al-Thani H. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res 2020; 15:249. [PMID: 32646448 PMCID: PMC7344030 DOI: 10.1186/s13018-020-01772-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality. Purpose We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.
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Affiliation(s)
- Husham Abdelrahman
- Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. .,Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen am Rhein, Germany
| | | | - Syed Imran Ghouri
- Orthopedic Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Elhadi Babikir
- Orthopedic Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Matthias Muenzberg
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen am Rhein, Germany
| | - Hassan Al-Thani
- Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
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Pisquiy JJ, Carter JT, Chan A, Kusnezov N, Adler A. Incidence of Pelvic Ring Fractures in the U.S. Military Population. Cureus 2020; 12:e6899. [PMID: 32190457 PMCID: PMC7061778 DOI: 10.7759/cureus.6899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Pelvic ring fractures occur frequently among the elderly population, but some studies demonstrate a bimodal distribution where the incidence is elevated among younger age groups as well. The mechanisms of injury also vary based on age groups. Previous studies are specific to trauma registries and centers, but epidemiological data within the U.S. military are sparse. In the U.S. military population, pelvic ring fractures can be related to high-energy trauma including motor vehicle accidents and combat warfare. The purpose of this study was to determine the incidence of pelvic ring fractures among active duty U.S. military service members between 2006 and 2015, while also describing the demographics associated with the findings. Materials and Methods All data were collected from the U.S. Defense Medical Epidemiology Database (DMED). To calculate the incidence rates, only first-time occurrences for pelvic ring fractures among military members were used. Each point was identified using International Classification of Diseases, Ninth Revision (ICD-9), clinical modification code 808 for “fractures of the pelvis.” A multivariate Poisson regression analysis was used to estimate the incidence rate per 1,000 person-years and 95% confidence intervals while controlling for sex, race, age, rank, and service. Rate ratios were calculated using different referent factors based on differences in sex, race, age, rank, and service branch. This study was IRB exempt as all the data used were de-identified patient data from the DMED system. Results Over the 10-year study period, a total of 4,802 incident cases of pelvic ring fractures, and a total of 13,748,429 person-years were documented. The overall incidence rate of pelvic ring fractures was 0.35 per 1,000 person-years. The incidence of pelvic ring fractures was highest among the youngest age group (<20 years) and among the lower-ranking service members. Additionally, other demographic groups such as the White race, female sex, and Army service members showed the highest incidence rates. Conclusion Our study determined baseline epidemiological data on incidence rates of pelvic ring fractures in the U.S. military. Patient demographics may be contributing factors, and the present analysis was able to elucidate associated underlying demographics. We demonstrated that the incidence was highest among the younger age groups, and that incidence rates may be specific to age cohorts. This study also found that lower-ranking service members had the highest incidence in all service branches, suggesting a form of occupational risk. Furthermore, our findings suggest that females, White race groups, and Army enlisted service members show a significantly higher incidence rate and may be at a greater risk. Our findings are important as they broaden the understanding of the patterns of pelvic ring fractures in the U.S. military population and occupational risks associated with this population.
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Affiliation(s)
- John J Pisquiy
- Orthopaedic Surgery, Texas Tech University Health Science Center, El Paso, USA
| | - Jordan T Carter
- Orthopaedics, Texas Tech University Health Sciences Center, El Paso, USA
| | - Andrew Chan
- Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, USA
| | - Nicholas Kusnezov
- Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, USA
| | - Adam Adler
- Orthopaedic Surgery, Texas Tech University Health Science Center, El Paso, USA
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Rega PP, Fink B, Sexton M, Schneiderman J, Kakish E, McKenzie N, Kenney K, Jones C. Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer. BMJ Mil Health 2019; 166:e21-e24. [PMID: 31123090 DOI: 10.1136/jramc-2019-001196] [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: 02/15/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable. However, obese victims or personnel with insufficient body strength may impede successful reduction. OBJECTIVE To demonstrate the value of an improvisational windlass (intravenous pole) in improving the ability to reduce an open-book pelvic fracture. METHODS The Institutional Review Board-approved study involved 28 diverse healthcare students and emergency medicine residents. Each participant's demographic information and physical characteristics were recorded. A METIman was prepared with knee and ankle binding and a sphygmomanometer set at 40 mm Hg placed over the symphysis pubis. Two-person teams were randomly selected to place a bedsheet at greater trochanter level and atop the sphygmomanometer. The bedsheet was secured with maximum effort by the pairs and the pressure recorded. Following this, the pairs inserted an intravenous pole in the knot and torqued the pole to maximum effort and a repeat pressure recorded. RESULTS The mean increase in pressure using only the bedsheet was 106.43 mm Hg per team. With bedsheet and intravenous pole, the mean pressure increase was 351.79 mm Hg per team. The difference was statistically significant (independent samples t-test: t = 17.177, p < 0.001, 95% CI (216.65 to 274.07 mm Hg). There was no correlation between pressure increases and the individual physical characteristics of the subjects (r = - 0.183, p = 0.352). CONCLUSIONS Regardless of personnel's physical attributes, the addition of an improvisational windlass to a pelvic circumferential compression bedsheet can improve the ability to reduce an open-book fracture, especially in obese victims.
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Affiliation(s)
- Paul Patrick Rega
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - B Fink
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - M Sexton
- College of Nursing, University of Toledo, Toledo, Ohio, USA
| | - J Schneiderman
- Interprofessional Immersive Simulation Center, University of Toledo, Toledo, Ohio, USA
| | - E Kakish
- Department of Emergency Medicine, University of Toledo, Toledo, Ohio, USA
| | - N McKenzie
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, Ohio, USA
| | - K Kenney
- School of Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - C Jones
- Department of Emergency Medicine, University of Toledo, Toledo, Ohio, USA
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