Abstract

MEJIA, David et al. Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality. Colomb. Med. [online]. 2020, vol.51, n.4, e4214510.  Epub Dec 30, 2020. ISSN 1657-9534.  https://doi.org/10.25100/cm.v51i4.4510.

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.

Keywords : Hemodynamically unstable; damage control; pelvic fracture; REBOA; algorithm; limited resource center.

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