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Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy

2014; British Editorial Society of Bone & Joint Surgery; Volume: 96-B; Issue: 9 Linguagem: Inglês

10.1302/0301-620x.96b9.33914

2049-4408

Cyril Mauffrey, Derly O. Cuellar, Fredric M. Pieracci, David J. Hak, E. Mark Hammerberg, Philip F. Stahel, Clay Cothren Burlew, Ernest E. Moore,

Trauma, Hemostasis, Coagulopathy, Resuscitation

Exsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy. This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation. Cite this article: Bone Joint J 2014; 96-B:1143–54.