Management of pelvic injuries in hemodynamically unstable polytrauma patients - Challenges and current updates

Ramesh Perumal; Dilip Chand Raja S; Sivakumar S P; Dheenadhayalan Jayaramaraju; Ramesh Kumar Sen; Vivek Trikha

doi:10.1016/j.jcot.2020.09.035

Management of pelvic injuries in hemodynamically unstable polytrauma patients - Challenges and current updates

J Clin Orthop Trauma. 2021 Jan;12(1):101-112. doi: 10.1016/j.jcot.2020.09.035. Epub 2020 Oct 6.

Authors

Ramesh Perumal¹, Dilip Chand Raja S², Sivakumar S P¹, Dheenadhayalan Jayaramaraju¹, Ramesh Kumar Sen³, Vivek Trikha⁴

Affiliations

¹ Department of Orthopedics and Trauma, Ganga Hospital, Coimbatore, 641043, India.
² Department of Spine Surgery, Ganga Hospital, Coimbatore, 641043, India.
³ Institute of Orthopedic Surgery, Max Super Specialty Hospital, Mohali, 160055, India.
⁴ Department of Orthopedics, All India Institute of Medical Science, New Delhi, 110029, India.

Abstract

Pelvic injuries are notorious for causing rapid exsanguination, and also due to concomitant injuries and complications, they have a relatively higher mortality rate. Management of pelvic fractures in hemodynamically unstable patients is a challenging task and has been variably approached. Over the years, various concepts have evolved, and different guidelines and protocols were established in regional trauma care centers based mainly on their previous experience, outcomes, and availability of resources. More recently, damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation are being employed in the management of these unstable injuries, without clear consensus or guidelines. In this background, we have performed a computerized search using the Cochrane Database of Systematic Reviews, Scopus, Embase, Web of Science, and PubMed databases on studies published over the past 30 years. This comprehensive review aims to consolidate available literature on the current epidemiology, diagnostics, resuscitation, and management options of pelvic fractures in polytraumatized patients with hemodynamic instability with particular focus on damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation.

Keywords: External fixation; Management; Pelvic fractures; Pelvic injury; Polytrauma.