Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality

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Abstract

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.

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Mejia, D., Parra, M. W., Ordoñez, C. A., Padilla, N., Caicedo, Y., Warr, S. P., … Moore, E. E. (2020). Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality. Colombia Medica. Facultad de Salud de la Universidad del Valle. https://doi.org/10.25100/cm.v51i4.4510

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