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Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption

Sadri, Hassan ; Nguyen-Tang, Thai ; Stern, Richard ; Hoffmeyer, Pierre ; Peter, Robin

In: Archives of Orthopaedic and Trauma Surgery, 2005, vol. 125, no. 7, p. 443-447

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    Titre
    • Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption
    Auteur
    • Sadri, Hassan. Orthopaedic Surgery Service, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    • Nguyen-Tang, Thai. Orthopaedic Surgery Service, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    • Stern, Richard. Orthopaedic Surgery Service, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    • Hoffmeyer, Pierre. Orthopaedic Surgery Service, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    • Peter, Robin. Orthopaedic Surgery Service, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Archives of Orthopaedic and Trauma Surgery, 2005, vol. 125, no. 7, p. 443-447. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:315991
    Summary
    Introduction: Hemorrhage is the leading cause of death in patients with a pelvic fracture. The majority of blood loss derives from injured retroperitoneal veins and broad cancellous bone surfaces. The emergency management of multiply injured patients with pelvic ring disruption and severe hemorrhage remains controversial. Although it is well accepted that the displaced pelvic ring injury must be rapidly reduced and stabilized, the methods by which control of hemorrhagic shock is achieved remain under discussion. It has been proposed to exclusively use external pelvic ring stabilization for control of hemorrhage by producing a ‘tamponade effect' of the pelvis. However, the frequency of clinically important arterial bleeding after external fixation of the pelvic ring remains unclear. We therefore undertook this retrospective review to attempt to answer this one important question: How frequently is arterial embolization necessary to control hemorrhage and restore hemodynamic stability after external pelvic ring fixation? Materials and methods: We performed a retrospective review of 55 consecutive patients who presented with unstable types B and C pelvic ring fractures. Those patients designated as being in hemorrhagic shock (defined as a systolic blood pressure less than 90mmHg after receiving 2L of intravenous crystalloid) were treated by application of the pelvic C-clamp. Patients who remained in hemorrhagic shock, or were determined to be in severe shock (defined as mandatory catecholamines or more than 12 blood transfusions over 2h), underwent therapeutic angiography within 24h in order to control bleeding. Results: Fourteen patients were identified as being hemodynamically unstable (ISS 30.1±11.3 points) and were treated with a C-clamp. In those patients with persistent hemodynamic instability, arterial embolization was performed. After C-clamp application, 5 of 14 patients required therapeutic angiography to control bleeding. Two patients died, one from multiple sources of bleeding and the other from an open pelvic fracture (total mortality 2/14, 14%). Conclusions: Although the C-clamp is effective in controlling hemorrhage, one must be aware of the need for arterial embolization to restore hemodynamic stability in a select subgroup of patients