Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures.

Autor: Schweigkofler U; Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany. Uwe.schweigkofler@bgu-frankfurt.de., Wohlrath B; Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany., Trentsch H; Institut für Notfallmedizin und Medizinmanagement, Schillerstr 53, 80336, Munich, Germany., Greipel J; Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscherstr.8, 82418, Murnau, Germany., Tamimi N; Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany., Hoffmann R; Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany., Wincheringer D; Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2018 Oct; Vol. 44 (5), pp. 747-752. Date of Electronic Publication: 2017 Oct 12.
DOI: 10.1007/s00068-017-0860-0
Abstrakt: Background: Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine.
Methods: We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures. Data were collected anonymously via a standardized case report.
Results: A total of 254 patients with suspected pelvic injuries from 12 different trauma centers were included in this study. In 95 out of 254 cases a per definition unstable pelvic fracture could be confirmed; 46 type B and 49 type C fractures was confirmed. Mechanical stability examination was carried out in 61% and revealed a sensitivity of 31.6% and a specificity of 92.2%. 11.5% (18 patients) actually showed a mechanical instability (6 B# 12 C#). Regardless, 166 patients (65.4%) received noninvasive external stabilization ahead of diagnostic imaging, as a result of clinical judgment. 72% (24×) showed signs of significant bleeding in the subsequent CT scans. 33 pelvic ring fractures (type B or C) had no prehospital stabilization.
Conclusion: Testing of mechanical stability of the pelvic ring was carried out less often and with lower consequences for the actual management than expected. It seems worthwhile to rather put on a pelvic binder at earliest occasion based on trauma mechanism or clinical findings to reduce the risk of serious pelvic bleeding.
Databáze: MEDLINE
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