Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures
Introduction
Pelvic fractures represent a significant challenge for physicians caring for the injured patient. Most pelvic fractures are the result of high-energy transfer from severe blunt trauma. Unstable pelvic fractures with haemodynamic instability are rare and have, besides a high morbidity rate, a high mortality rate.8, 9, 10, 11, 17, 18, 20 An unstable pelvic fracture can be associated with significant bleeding, resulting in a hypovolaemic shock. Initial treatment is based on reduction of the pelvic volume, before operative stabilization of the pelvic ring is carried out. It is believed that by reducing the pelvic volume, a tamponade-like effect occurs.9, 13, 18 Over the last few decades, the most used non-invasive method for reducing the pelvic volume has been the pelvic binder,15 which is wrapped around the pelvis circumferentially. In the last years new pelvic circumferential compression devices have become available, which seem to be effective in early stabilization of unstable pelvic fractures16: the SAM Pelvic Sling® (SAM Medical Products) and the Trauma Pelvic Orthotic Device (T-POD®, Pyng Medical). The latter distributes the pressure by one traction cable, resulting in a greater reduction of the pelvic volume. Clinical studies on the compressive effect of the T-POD® have not been conducted yet. The aim of this study is to measure the effect of the T-POD® on reducing the pelvic volume and on haemodynamic stability.
Section snippets
Methods
During the period of 2004–2007, patients with a prehospital untreated unstable pelvic fracture, who presented on the emergency room of our level 1 trauma centre, were included in the study. Patients with a pelvic binder that had already been applied in the prehospital period by paramedics, were excluded. All pelvic fractures were classified, by AP pelvic film or computed tomographic scans of the pelvis, by one senior author (AvV) according to the classification of Tile.17 Before and immediately
Results
During the 4-year period 63 patients with an unstable pelvic fracture presented initially at our level 1 trauma centre. Of these, 15 consecutive patients (4 females), with a prehospital untreated unstable pelvic fracture, were included. The median age of the patients was 44 years (range 17–58) and the mean Injury Severity Score (ISS) was 35 (range 16–59). Nine patients suffered a pelvic fracture type Tile B (B1 = 3; B3 = 6) and 6 Tile C (C1 = 3; C2 = 2; C3 = 1). Three patients died, two patients due to
Discussion
Our patient series is one of the first to demonstrate the effect of the T-POD® on haemodynamical stability in a clinical setting in a group of patients with prehospital untreated unstable pelvic fractures. We have found a statistical significant reduction of the symphyseal diastasis and significant positive changes in circulatory parameters. The treatment of unstable pelvic fractures is important, and research is difficult, because most patients with an unstable pelvic fracture also have other
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Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients
2020, InjuryCitation Excerpt :This then led to the development and introduction of formal pelvic circumferential compression devices (PCCDs) [15]. PCCDs have been shown to improve the position and stability of open-book type pelvic fractures, providing significant reduction in measured pubic symphysis diastasis [16–20] and improvement in patient haemodynamics following their application [20]. Though effective, the placement of PCCDs has the potential to cause adverse outcomes including low-pressure necrosis to underlying soft tissue. [18,21–24]
Clinical Examination of the Pelvic Ring in the Prehospital Phase
2019, Air Medical Journal