Pre-Peritoneal Pelvic Pack with External Fixator Versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; A Historical Cohort Study

Abstract

Mohammad Amin Agah MD, Shahram Paydar MD, Hadi Khoshmohabat MD and Sadra Nikseresht MD

Purpose: Pelvic fracture is one of the most common cause of death in traumatic patients. It is due to high-energy trauma and approximately 80% of patients who develop severe hemorrhagic shock after a high-energy trauma die in the early stages. Unstable hemodynamic state due to pelvic fracture needs early fixation which supposed as a part of the resuscitation. This study was designed to compare the outcome, morbidity and complications of treatment with pre-peritoneal pelvic pack with external fixator against pelvic pack alone in traumatic pelvic fracture and unstable hemodynamic patients.

Methods: In a retrospective case control study, patients with pelvic fracture and unstable hemodynamic state who referred to emergency and surgery department of Shahid Rajaei Hospital, Shiraz, Iran from august 2018 to august 2019 were enrolled by census manner. In the control group, 25 patients treated just by a pre-peritoneal pack (PPP group), while in the case group, pre-peritoneal pack and external fixator was done as the procedure to control bleeding (PPP Plus fixator group) in 22 individuals. All study procedures and data gathering was approved by the committee of ethics in Baghiatollah University of medical sciences. Two groups were compared for presence of thromboembolism, hospital stay, infection, BUN, creatinine, rate of blood transfusion and mortality.

Results: Mean age of participants were 34.48±13.79 in pelvic pack group, while it was reported 32.36±16.29 in PPP plus external fixator ones. Mean of Injury Severity Score (ISS) (13) was measured 23.12±9.85 in Pelvic Pack group, while it was calculated 19.22±8.09 in PPP plus external fixator group. Acute kidney injury was reported in 6 (24%) individuals of PPP group, while its rate in PPP plus fixator group was 40.9%. Mortality rate was reported 32% and 4.5 % in control and case groups, respectively. There was a significant difference between groups (P-Value = 0.017, LR=6.42). VTE was reported 12% and 4.5 % in PPP group and PPP plus fixator ones, respectively.

Conclusion: It was concluded that using external fixation with PPP can be a useful method for treatment of pelvic fractures with unstable hemodynamic situations. It is recommended to use biomarkers like lactate or others to determine the situation of patients as precise as possible.

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