HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

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

AbstractINTRODUCTION:
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 90 mmHg after receiving 2 L 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 2 h), underwent therapeutic angiography within 24 h 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.
AuthorsHassan Sadri, Thai Nguyen-Tang, Richard Stern, Pierre Hoffmeyer, Robin Peter
JournalArchives of orthopaedic and trauma surgery (Arch Orthop Trauma Surg) Vol. 125 Issue 7 Pg. 443-7 (Sep 2005) ISSN: 0936-8051 [Print] Germany
PMID15977021 (Publication Type: Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Angiography
  • Blood Transfusion (statistics & numerical data)
  • Constriction
  • Embolization, Therapeutic
  • External Fixators
  • Female
  • Fractures, Bone (complications, therapy)
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Pelvic Bones (injuries)
  • Retrospective Studies
  • Shock, Hemorrhagic (etiology, prevention & control)
  • Surgical Instruments
  • Treatment Outcome

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: