Unstable pelvic fractures: Pelvic packing is still required in the era of angioembolization? A 3 year trauma center experience

Abstract text (incl. references and figure legends)

Introduction: Unstable pelvic fractures are among the most difficult injuries to treat and require a strong multidisciplinary approach. In the era of angioembolization, the prognosis of these complex fractures has progressively improved. The aim of this study is to question the topicality of pelvic packing as a method of stabilization in the era of angioembolization and external fixators.

Materials and Methods: From 01/09/2019 to 30/09/2022 were 401 patients admitted with a diagnosis of pelvic fracture. The following data were considered: degree of injury with Young and Burgees classification, need of angioembolization, need of external fixation, need of pelvic packing length of hospitalization, mortality.

Results: All unstable patients required angioembolization and 90% of them required external fixators. Just in 2 cases we performed a pelvic packing due to a venous unstoppable bleeding and both died in the first 48 h.

Conclusions: Pelvic packing remains an extreme rescue attempt for those patients who have a venous bleeding and those who angioembolization and external fixators do not give stability, but in our experience this kind of treatment is burdened with almost certain mortality. In our hospital a standardized and multidisciplinary protocol is in place whenever a pelvic fracture is diagnosed. Both stable and unstable pelvic fractures undergo immediate angiography followed by external fixation when the injury requires it. This type of protocol allows in our experience to be timely in blocking bleeding, improving prognosis, and reducing mortality.

References:

Lin SS, Zhou SG, He LS, Zhang ZX, Zhang XM. The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures. Chin J Traumatol. 2021 Mar;24(2):100-103. doi: 10.1016/j.cjtee.2021.01.008. Lopez PP. Unstable pelvic fractures: the use of angiography in controlling arterial hemorrhage. J Trauma. 2007 Jun;62(6 Suppl):S30-1. doi: 10.1097/TA.0b013e3180654086.

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