Preperitoneal pelvic packing is effective for hemorrhage control in open pelvic fractures

• Published in: The American journal of surgery Vol. 215; no. 4; pp. 675 - 677
• Main Authors: Moskowitz, Eliza E., Burlew, Clay Cothren, Moore, Ernest E., Pieracci, Fredric M., Fox, Charles J., Campion, Eric M., Lawless, Ryan A., Cohen, Mitchell J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018; Elsevier Limited
• Subjects: Adult; Antibiotics; Brain; Emergency medical care; Female; Fracture Fixation - methods; Fractures; Fractures, Bone - complications; Fractures, Bone - mortality; Fractures, Bone - surgery; Fractures, Open - complications; Fractures, Open - mortality; Fractures, Open - surgery; Head injuries; Hemorrhage; Hemorrhage - etiology; Hemorrhage - mortality; Hemorrhage - prevention & control; Hemostatic Techniques; Humans; Injuries; Injury Severity Score; Intensive care; Male; Mortality; Open pelvic fractures; Packaging; Patients; Pelvic Bones - injuries; Pelvic fractures; Preperitoneal pelvic packing; Rectum; Shock; Surgeons; Surgery; Trauma; Trauma centers; Traumatic brain injury; Treatment Outcome; Vagina; Shock; Open pelvic fractures; Pelvic fractures; Preperitoneal pelvic packing; Trauma; Hemorrhage
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.11.024

Open pelvic fractures are life-threatening injuries. Preperitoneal pelvic packing (PPP) has been suggested to be ineffective for hemorrhage control in open pelvic fractures. We hypothesize that PPP is effective at hemorrhage control in patients with open pelvic fractures and reduces mortality. Patients undergoing PPP from 2005 to 2015 were analyzed. Patients with open pelvic fractures were defined as direct communication of the bony injury with overlying soft tissue, vagina, or rectum. During the 10-year study, 126 patients underwent PPP; 14 (11%) sustained an open pelvic fracture. After PPP, 1 patient (7%) underwent angioembolization with a documented arterial blush. PPP controlled pelvic hemorrhage in all patients. Overall mortality rate was 7% with one death due to traumatic brain injury. PPP is effective for hemorrhage control in patients with open pelvic fractures. PPP should be used in a standard protocol for hemodynamically unstable patients with pelvic fractures regardless of associated perineal injuries.