Pelvic Fractures and the Unstable Patient

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Pelvic Packing • Historically: Open exploration and ligation Difficult access, wide collateralization Bloody fatal mess 70’s-80’s: Pelvic should never be opened for bleeding fractures • Shouldn’t delay hemostasis waiting for IR Damage control Laparotomy and PACKING • Ertel, 2001: 20 pts Laparotomy and packing after c-clamp 5 had intraabdominal injuries 4 deaths from hemorrhagic shock, 1 from sepsis
Pre-peritoneal Packing • Direct packing of retroperitoneum • Keeps you of out the abdomen • Faster (20min), easier, less invasive than open packing • How is it done?
Page 1 and 2:
Pelvic Fractures and the Unstable P
Page 3 and 4: Scope of the Problem • Pelvic fra
Page 5 and 6: History • 1970 Hawkins, L. Journa
Page 7 and 8: Anatomy • 2 innominate bones (ari
Page 9 and 10: Vascular Anatomy • Large blood ve
Page 11 and 12: Pelvic Volume
Page 13 and 14: Lateral Compression • Acute short
Page 15 and 16: • Usually a fall from height land
Page 17 and 18: Diagnosis of Fracture • Strong su
Page 19 and 20: Diagnosis of Fracture • Salvino 1
Page 21 and 22: Diagnosing Bleeding • Vascular in
Page 23 and 24: Markers for pelvic hemorrhage • P
Page 25 and 26: Markers for pelvic hemorrhage • C
Page 27 and 28: Polytrauma • Pelvic fractures com
Page 29 and 30: The Unstable Patient • Difficult
Page 31 and 32: The Unstable Patient • Pelvic sta
Page 33 and 34: What can be done? •MAST • Compr
Page 35 and 36: Compressive Devices • Adjunct to
Page 38: Compressive Devices • Lee C. (200
Page 41 and 42: External Fixation
Page 44 and 45: Angiography and Embolization • St
Page 46 and 47: Angiography and Embolization • Se
Page 48: Angiography and Embolization • Pr
Page 52 and 53: Don’t be scared
Page 56: Technique • Low midline incision
Page 60: Pre-peritoneal Packing • Cothren
Page 64 and 65: Putting it all together… • Hemo
Page 66 and 67: “You can only do what you can do,
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Pelvic Fractures and the Unstable Patient

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