Shi-Shui Lin,Shi-Guo Zhou,Lin-Sheng He,Zhong-Xiang Zhang,Xu-Ming Zhang.[J].Chin J Traumatol,2021,24(2):100-103. [doi]
The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures
  
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KeyWord: Pelvic fracturesPreperitoneal pelvic packingHaemorrhage shockMultidiscipline cooperation
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Author NameAffiliation
Shi-Shui Lin Department of Orthopedic Surgery, Fujian Provincial Hospital Jinshan Branch, Fuzhou, 350028, China
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China 
Shi-Guo Zhou Department of Orthopedic Surgery, Fujian Provincial Hospital Jinshan Branch, Fuzhou, 350028, China
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China 
Lin-Sheng He Department of Orthopedic Surgery, General Hospital of Jianning County, Jianning County, Sanming City, 354500, Fujian Province, China 
Zhong-Xiang Zhang Department of Orthopedic Surgery, Traditional Chinese Medicine Hospital of Lianjiang, Lianjiang County, Fuzhou, 350500, China 
Xu-Ming Zhang Department of Trauma Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China 
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Abstract:
      Purpose: Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures. Methods: This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure 90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test. Results: The patients’ average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05).After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67). Conclusions: Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.
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