Pelvic Trauma

The fellow should be able to:

• Demonstrate an understanding of pelvic fracture management and initial treatment
• Describe the classification categories for pelvic fractures
• Recognize the role of multidisciplinary care in complex pelvic fractures
• Describe the role of observation vs angioembolization in severe pelvic trauma associated with contrast blush
• Describe the role and technique for pre-peritoneal pelvic packing in pelvic trauma management
• Understand the complications associated with angioembolization and pre-peritoneal pelvic packing

Resources

• Topic Summary
• AAST Education Module - Pelvic Vascular Injuries
• Meet the Mentors - Complex Pelvic Fracture Management
• Meet the Mentors - Pelvic Trauma
• Overview Article
  • Joseph J. DuBose, MD, FACS, FCCM, FSVS, Clay Cothren Burlew, MD; et al. Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control. J Trauma 2021.
• Additional Resources
  • Preperitoneal Pelvic Packing
    • Li P, Liu F, Li Q, Zhou D, Dong J, and Wang D. Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis, Journal of Orthopedics and Traumatology 2022
    • Clay Cothren Burlew, MD; Ernest E. Moore, MD; et al. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma 2017:
    • Jack M. McDonogh, B Med; Daniel P. Lewis, B Med; et al. Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma 2022.
  • Angioembolization
    • R, Waldron J, Scott A, and Nasr K. Angiography and embolization in the management of bleeding pelvic fractures. J Am Acad Orthop Surg 2018
  • REBOA
    • Jansen JO, Hudson J, and Cochran C. ED REBOA in patients with exsanguinating hemorrhage. JAMA 2023
  • Combination REBOA and PPP
    • Werner NL, Moore EE, Hoehn M, Lawless R, Coleman JR, Freedberg M, et al. Inflate and pack!  Pelvic packing combined with REBOA deployment prevent hemorrhage related deaths in unstable pelvic fractures. Injury 2022.
  • Todd W. Constantini, MD; Raul Coimbra, MD, PhD; et al. Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg. 2016.
  • Ronald Brian Tesoriero, MD; Brandon R. Bruns, MD; et al. Angiographic embolization for hemorrhage following pelvic fracture: Is it “time” for a paradigm shift? J Trauma Acute Care Surg. 2016.
• Multimedia Resources 
  • Burlew CC. Preperitoneal Pelvic Packing: A 2018 EAST Master Class Video Presentation.
  • Podcast: Behind the Knife - BIG T Trauma Series, Ep. 16 - Pelvic Fractures