Pelvis Kırıkları
Özet
Pelvis kırıkları, sakrum ve innominate kemiklerden oluşan pelvik yapının travmatik yaralanmalarıdır. Gençlerde yüksek enerji, yaşlılarda orta enerji mekanizmalarıyla oluşur. Yaralanmalar %3 oranında görülür ve mortalite oranı %4-%28 arasında değişir. Klinik değerlendirmede doğru ve erken resüsitasyon önemlidir. Görüntüleme yöntemleri arasında X-ray, ultrason, BT ve MRG bulunur. Tedavi, hemodinamik stabilizasyona ve kırık stabilizasyonuna odaklanır. Erken stabilizasyon için pelvik kemerler, eksternal ve internal fiksatörler kullanılır. Preperitoneal pelvis tamponlama ve angioembolizasyon, kanama kontrolü için önemli yöntemlerdir. Hemodinamik instabilite ve kompartman sendromu gibi komplikasyonlar dikkatle yönetilmelidir.
Pelvic fractures involve traumatic injuries to the sacrum and innominate bones. They occur through high-energy mechanisms in young individuals and moderate-energy mechanisms in the elderly. The incidence is about 3%, with mortality rates ranging from 4% to 28%. Clinical evaluation requires accurate and early resuscitation. Imaging methods include X-ray, ultrasound, CT, and MRI. Treatment focuses on hemodynamic stabilization and fracture stabilization. Early stabilization utilizes pelvic belts, external, and internal fixators. Preperitoneal pelvic packing and angioembolization are critical for hemorrhage control. Complications such as hemodynamic instability and compartment syndrome must be managed carefully.
Referanslar
Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World Journal of Emergency Surgery. 2017;12(1):5. doi:10.1186/s13017-017-0117-6
Harrison A, Ordas-Bayon A, Chimutengwende-Gordon M, et al. Factors associated with mortality in older patients sustaining pelvic or acetabular fractures. Arch Orthop Trauma Surg. 2022;142(7):1547-1556. doi:10.1007/s00402-021-03873-5
Mi M, Kanakaris NK, Wu X, Giannoudis P V. Management and outcomes of open pelvic fractures: An update. Injury. 2021;52(10):2738-2745. doi:10.1016/j.injury.2020.02.096
Dechert TA, Duane TM, Frykberg BP, Aboutanos MB, Malhotra AK, Ivatury RR. Elderly Patients with Pelvic Fracture: Interventions and Outcomes. Am Surg. 2009;75(4):291-295. doi:10.1177/000313480907500405
Schulman JE, O’Toole R V., Castillo RC, et al. Pelvic Ring Fractures Are an Independent Risk Factor for Death After Blunt Trauma. Journal of Trauma: Injury, Infection & Critical Care. 2010;68(4):930-934. doi:10.1097/TA.0b013e3181cb49d1
Gänsslen A, Giannoudis P, Pape HC. Hemorrhage in pelvic fracture: who needs angiography? Curr Opin Crit Care. 2003;9(6):515-523. doi:10.1097/00075198-200312000-00009
Magnussen RA, Tressler MA, Obremskey WT, Kregor PJ. Predicting Blood Loss in Isolated Pelvic and Acetabular High-Energy Trauma. J Orthop Trauma. 2007;21(9):603-607. doi:10.1097/BOT.0b013e3181599c27
Elzik ME, Dirschl DR, Dahners LE. Hemorrhage in Pelvic Fractures Does Not Correlate With Fracture Length. Journal of Trauma: Injury, Infection & Critical Care. 2008;65(2):436-441. doi:10.1097/TA.0b013e31817c5554
Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic Fractures: Epidemiology and Predictors of Associated Abdominal Injuries and Outcomes1. J Am Coll Surg. 2002;195(1):1-10. doi:10.1016/S1072-7515(02)01197-3
KANEKO T, YANAGIDA K, MATSUI K, et al. Predictive Factors of Lower Urinary Tract Injuries and Spontaneous Voiding Failure After Pelvic Fractures. In Vivo (Brooklyn). 2023;37(3):1323-1327. doi:10.21873/invivo.13212
Schmal H, Hauschild O, Culemann U, et al. Identification of Risk Factors for Neurological Deficits in Patients with Pelvic Fractures. Orthopedics. 2010;33(8). doi:10.3928/01477447-20100625-13
Advanced trauma life support (ATLS®). Journal of Trauma and Acute Care Surgery. 2013;74(5):1363-1366. doi:10.1097/TA.0b013e31828b82f5
Ballard RB, Rozycki GS, Newman PG, et al. An algorithm to reduce the incidence of false-negative FAST∗∗∗Focused Assessment for the Sonographic Examination of the Trauma patient. examinations in patients at high risk for occult injury11No competing interests declared. J Am Coll Surg. 1999;189(2):145-150. doi:10.1016/S1072-7515(99)00121-0
Christian NT, Burlew CC, Moore EE, et al. The focused abdominal sonography for trauma examination can reliably identify patients with significant intra-abdominal hemorrhage in life-threatening pelvic fractures. Journal of Trauma and Acute Care Surgery. 2018;84(6):924-928. doi:10.1097/TA.0000000000001838
Chaijareenont C, Krutsri C, Sumpritpradit P, et al. FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis. Annals of Medicine and Surgery. 2020;60:175-181. doi:10.1016/j.amsu.2020.10.018
Tang J, Shi Z, Hu J, et al. Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis. Am J Emerg Med. 2019;37(4):571-578. doi:10.1016/j.ajem.2018.06.027
Altunbas E, Omercikoglu S, Akoglu H, Denizbasi A. Prognostic value of 2-hour lactate level and lactate clearance for 30-day mortality and comparison with trauma scores in multi-trauma patients. Pak J Med Sci. 2018;34(3). doi:10.12669/pjms.343.14294
Tran TLN, Brasel KJ, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in Trauma. Journal of Trauma and Acute Care Surgery. 2016;81(6):1171-1174. doi:10.1097/TA.0000000000001230
Davis JW, Moore FA, McIntyre RC, Cocanour CS, Moore EE, West MA. Western Trauma Association Critical Decisions in Trauma: Management of Pelvic Fracture With Hemodynamic Instability. Journal of Trauma: Injury, Infection & Critical Care. 2008;65(5):1012-1015. doi:10.1097/TA.0b013e318189a836
Choi K, Keum MA, Choi B, et al. Effectiveness and safety of bilateral internal iliac artery ligation with pre-peritoneal pelvic packing for life-threatening pelvic trauma. Injury. 2023;54(2):598-603. doi:10.1016/j.injury.2022.11.003
Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World Journal of Emergency Surgery. 2021;16(1):41. doi:10.1186/s13017-021-00386-9
Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005;59(3):659-664.
Burlew CC, Moore EE, Stahel PF, et al. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. Journal of Trauma and Acute Care Surgery. 2017;82(2):233-242. doi:10.1097/TA.0000000000001324
Moskowitz EE, Burlew CC, Moore EE, et al. Preperitoneal pelvic packing is effective for hemorrhage control in open pelvic fractures. The American Journal of Surgery. 2018;215(4):675-677. doi:10.1016/j.amjsurg.2017.11.024
Bugaev N, Rattan R, Goodman M, et al. Preperitoneal packing for pelvic fracture-associated hemorrhage: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. The American Journal of Surgery. 2020;220(4):873-888. doi:10.1016/j.amjsurg.2020.05.037
Parks JJ, Naar L, Bokenkamp M, et al. Preperitoneal Pelvic Packing is Associated With Increased Risk of Venous Thromboembolism. Journal of Surgical Research. 2022;280:85-93. doi:10.1016/j.jss.2022.06.075
Tesoriero RB, Bruns BR, Narayan M, et al. Angiographic embolization for hemorrhage following pelvic fracture. Journal of Trauma and Acute Care Surgery. 2017;82(1):18-26. doi:10.1097/TA.0000000000001259
Harfouche M, Inaba K, Cannon J, et al. Patterns and outcomes of zone 3 REBOA use in the management of severe pelvic fractures: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database. Journal of Trauma and Acute Care Surgery. 2021;90(4):659-665. doi:10.1097/TA.0000000000003053
He L, Yi C, Hou Z, Hak DJ. Intraabdominal hypertension/abdominal compartment syndrome after pelvic fractures: How they occur and what can be done? Injury. 2019;50(4):919-925. doi:10.1016/j.injury.2019.03.037
Moore FA, McKinley BA, Moore EE, et al. Inflammation and the Host Response to Injury, a Large-Scale Collaborative Project: Patient-Oriented Research Core???Standard Operating Procedures for Clinical Care. The Journal of Trauma: Injury, Infection, and Critical Care. 2006;61(1):82-89. doi:10.1097/01.ta.0000225933.08478.65
Menaker J, Stein DM, Scalea TM. Incidence of Early Pulmonary Embolism After Injury. Journal of Trauma: Injury, Infection & Critical Care. 2007;63(3):620-624. doi:10.1097/TA.0b013e31812f60aa
Martínez-Rondanelli A, Gomez-Sierra MA, Ossa AA, Hernández RD, Torres M. Damage Control in Orthopedics and Traumatology. Colomb Med. 2021;52(2):e4184802. doi:10.25100/cm.v52i2.4802
Andruszkow H, Haasper C, Lob G, et al. Status of Road Safety and Injury Burden. J Orthop Trauma. 2014;28(Supplement 1):S39-S40. doi:10.1097/BOT.0000000000000110
Sauaia A, Moore EE, Johnson JL, et al. Temporal trends of postinjury multiple-organ failure. Journal of Trauma and Acute Care Surgery. 2014;76(3):582-593. doi:10.1097/TA.0000000000000147
Grünherz L, Jensen KO, Neuhaus V, et al. Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions? European Journal of Trauma and Emergency Surgery. 2018;44(1):3-8. doi:10.1007/s00068-017-0816-4
Cotton BA, Reddy N, Hatch QM, et al. Damage Control Resuscitation Is Associated With a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients. Ann Surg. 2011;254(4):598-605. doi:10.1097/SLA.0b013e318230089e
Pfeifer R, Heussen N, Michalewicz E, Hilgers RD, Pape HC. Incidence of adult respiratory distress syndrome in trauma patients. Journal of Trauma and Acute Care Surgery. 2017;83(3):496-506. doi:10.1097/TA.0000000000001571
Ogura T, Nakamura Y, Nakano M, et al. Predicting the need for massive transfusion in trauma patients. Journal of Trauma and Acute Care Surgery. 2014;76(5):1243-1250. doi:10.1097/TA.0000000000000200
L B Bone 1 KDJJWRS. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71(3):336-340.
Palmer CS, Gabbe BJ, Cameron PA. Defining major trauma using the 2008 Abbreviated Injury Scale. Injury. 2016;47(1):109-115. doi:10.1016/j.injury.2015.07.003
Guerado E, Bertrand ML, Cano JR, Cerván AM, Galán A. Damage control orthopaedics: State of the art. World J Orthop. 2019;10(1):1-13. doi:10.5312/wjo.v10.i1.1
Dezman ZDW, Comer AC, Smith GS, Narayan M, Scalea TM, Hirshon JM. Failure to clear elevated lactate predicts 24-hour mortality in trauma patients. Journal of Trauma and Acute Care Surgery. 2015;79(4):580-585. doi:10.1097/TA.0000000000000810
Pape HC, Andruszkow H, Pfeifer R, Hildebrand F, Barkatali BM. Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery. Injury. 2016;47(4):787-791. doi:10.1016/j.injury.2016.03.020
Giannoudis PV, Giannoudis VP, Horwitz DS. Time to think outside the box: ‘Prompt-Individualised-Safe Management’ (PR.I.S.M.) should prevail in patients with multiple injuries. Injury. 2017;48(7):1279-1282. doi:10.1016/j.injury.2017.05.026
Referanslar
Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World Journal of Emergency Surgery. 2017;12(1):5. doi:10.1186/s13017-017-0117-6
Harrison A, Ordas-Bayon A, Chimutengwende-Gordon M, et al. Factors associated with mortality in older patients sustaining pelvic or acetabular fractures. Arch Orthop Trauma Surg. 2022;142(7):1547-1556. doi:10.1007/s00402-021-03873-5
Mi M, Kanakaris NK, Wu X, Giannoudis P V. Management and outcomes of open pelvic fractures: An update. Injury. 2021;52(10):2738-2745. doi:10.1016/j.injury.2020.02.096
Dechert TA, Duane TM, Frykberg BP, Aboutanos MB, Malhotra AK, Ivatury RR. Elderly Patients with Pelvic Fracture: Interventions and Outcomes. Am Surg. 2009;75(4):291-295. doi:10.1177/000313480907500405
Schulman JE, O’Toole R V., Castillo RC, et al. Pelvic Ring Fractures Are an Independent Risk Factor for Death After Blunt Trauma. Journal of Trauma: Injury, Infection & Critical Care. 2010;68(4):930-934. doi:10.1097/TA.0b013e3181cb49d1
Gänsslen A, Giannoudis P, Pape HC. Hemorrhage in pelvic fracture: who needs angiography? Curr Opin Crit Care. 2003;9(6):515-523. doi:10.1097/00075198-200312000-00009
Magnussen RA, Tressler MA, Obremskey WT, Kregor PJ. Predicting Blood Loss in Isolated Pelvic and Acetabular High-Energy Trauma. J Orthop Trauma. 2007;21(9):603-607. doi:10.1097/BOT.0b013e3181599c27
Elzik ME, Dirschl DR, Dahners LE. Hemorrhage in Pelvic Fractures Does Not Correlate With Fracture Length. Journal of Trauma: Injury, Infection & Critical Care. 2008;65(2):436-441. doi:10.1097/TA.0b013e31817c5554
Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic Fractures: Epidemiology and Predictors of Associated Abdominal Injuries and Outcomes1. J Am Coll Surg. 2002;195(1):1-10. doi:10.1016/S1072-7515(02)01197-3
KANEKO T, YANAGIDA K, MATSUI K, et al. Predictive Factors of Lower Urinary Tract Injuries and Spontaneous Voiding Failure After Pelvic Fractures. In Vivo (Brooklyn). 2023;37(3):1323-1327. doi:10.21873/invivo.13212
Schmal H, Hauschild O, Culemann U, et al. Identification of Risk Factors for Neurological Deficits in Patients with Pelvic Fractures. Orthopedics. 2010;33(8). doi:10.3928/01477447-20100625-13
Advanced trauma life support (ATLS®). Journal of Trauma and Acute Care Surgery. 2013;74(5):1363-1366. doi:10.1097/TA.0b013e31828b82f5
Ballard RB, Rozycki GS, Newman PG, et al. An algorithm to reduce the incidence of false-negative FAST∗∗∗Focused Assessment for the Sonographic Examination of the Trauma patient. examinations in patients at high risk for occult injury11No competing interests declared. J Am Coll Surg. 1999;189(2):145-150. doi:10.1016/S1072-7515(99)00121-0
Christian NT, Burlew CC, Moore EE, et al. The focused abdominal sonography for trauma examination can reliably identify patients with significant intra-abdominal hemorrhage in life-threatening pelvic fractures. Journal of Trauma and Acute Care Surgery. 2018;84(6):924-928. doi:10.1097/TA.0000000000001838
Chaijareenont C, Krutsri C, Sumpritpradit P, et al. FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis. Annals of Medicine and Surgery. 2020;60:175-181. doi:10.1016/j.amsu.2020.10.018
Tang J, Shi Z, Hu J, et al. Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis. Am J Emerg Med. 2019;37(4):571-578. doi:10.1016/j.ajem.2018.06.027
Altunbas E, Omercikoglu S, Akoglu H, Denizbasi A. Prognostic value of 2-hour lactate level and lactate clearance for 30-day mortality and comparison with trauma scores in multi-trauma patients. Pak J Med Sci. 2018;34(3). doi:10.12669/pjms.343.14294
Tran TLN, Brasel KJ, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in Trauma. Journal of Trauma and Acute Care Surgery. 2016;81(6):1171-1174. doi:10.1097/TA.0000000000001230
Davis JW, Moore FA, McIntyre RC, Cocanour CS, Moore EE, West MA. Western Trauma Association Critical Decisions in Trauma: Management of Pelvic Fracture With Hemodynamic Instability. Journal of Trauma: Injury, Infection & Critical Care. 2008;65(5):1012-1015. doi:10.1097/TA.0b013e318189a836
Choi K, Keum MA, Choi B, et al. Effectiveness and safety of bilateral internal iliac artery ligation with pre-peritoneal pelvic packing for life-threatening pelvic trauma. Injury. 2023;54(2):598-603. doi:10.1016/j.injury.2022.11.003
Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World Journal of Emergency Surgery. 2021;16(1):41. doi:10.1186/s13017-021-00386-9
Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005;59(3):659-664.
Burlew CC, Moore EE, Stahel PF, et al. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. Journal of Trauma and Acute Care Surgery. 2017;82(2):233-242. doi:10.1097/TA.0000000000001324
Moskowitz EE, Burlew CC, Moore EE, et al. Preperitoneal pelvic packing is effective for hemorrhage control in open pelvic fractures. The American Journal of Surgery. 2018;215(4):675-677. doi:10.1016/j.amjsurg.2017.11.024
Bugaev N, Rattan R, Goodman M, et al. Preperitoneal packing for pelvic fracture-associated hemorrhage: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. The American Journal of Surgery. 2020;220(4):873-888. doi:10.1016/j.amjsurg.2020.05.037
Parks JJ, Naar L, Bokenkamp M, et al. Preperitoneal Pelvic Packing is Associated With Increased Risk of Venous Thromboembolism. Journal of Surgical Research. 2022;280:85-93. doi:10.1016/j.jss.2022.06.075
Tesoriero RB, Bruns BR, Narayan M, et al. Angiographic embolization for hemorrhage following pelvic fracture. Journal of Trauma and Acute Care Surgery. 2017;82(1):18-26. doi:10.1097/TA.0000000000001259
Harfouche M, Inaba K, Cannon J, et al. Patterns and outcomes of zone 3 REBOA use in the management of severe pelvic fractures: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database. Journal of Trauma and Acute Care Surgery. 2021;90(4):659-665. doi:10.1097/TA.0000000000003053
He L, Yi C, Hou Z, Hak DJ. Intraabdominal hypertension/abdominal compartment syndrome after pelvic fractures: How they occur and what can be done? Injury. 2019;50(4):919-925. doi:10.1016/j.injury.2019.03.037
Moore FA, McKinley BA, Moore EE, et al. Inflammation and the Host Response to Injury, a Large-Scale Collaborative Project: Patient-Oriented Research Core???Standard Operating Procedures for Clinical Care. The Journal of Trauma: Injury, Infection, and Critical Care. 2006;61(1):82-89. doi:10.1097/01.ta.0000225933.08478.65
Menaker J, Stein DM, Scalea TM. Incidence of Early Pulmonary Embolism After Injury. Journal of Trauma: Injury, Infection & Critical Care. 2007;63(3):620-624. doi:10.1097/TA.0b013e31812f60aa
Martínez-Rondanelli A, Gomez-Sierra MA, Ossa AA, Hernández RD, Torres M. Damage Control in Orthopedics and Traumatology. Colomb Med. 2021;52(2):e4184802. doi:10.25100/cm.v52i2.4802
Andruszkow H, Haasper C, Lob G, et al. Status of Road Safety and Injury Burden. J Orthop Trauma. 2014;28(Supplement 1):S39-S40. doi:10.1097/BOT.0000000000000110
Sauaia A, Moore EE, Johnson JL, et al. Temporal trends of postinjury multiple-organ failure. Journal of Trauma and Acute Care Surgery. 2014;76(3):582-593. doi:10.1097/TA.0000000000000147
Grünherz L, Jensen KO, Neuhaus V, et al. Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions? European Journal of Trauma and Emergency Surgery. 2018;44(1):3-8. doi:10.1007/s00068-017-0816-4
Cotton BA, Reddy N, Hatch QM, et al. Damage Control Resuscitation Is Associated With a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients. Ann Surg. 2011;254(4):598-605. doi:10.1097/SLA.0b013e318230089e
Pfeifer R, Heussen N, Michalewicz E, Hilgers RD, Pape HC. Incidence of adult respiratory distress syndrome in trauma patients. Journal of Trauma and Acute Care Surgery. 2017;83(3):496-506. doi:10.1097/TA.0000000000001571
Ogura T, Nakamura Y, Nakano M, et al. Predicting the need for massive transfusion in trauma patients. Journal of Trauma and Acute Care Surgery. 2014;76(5):1243-1250. doi:10.1097/TA.0000000000000200
L B Bone 1 KDJJWRS. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71(3):336-340.
Palmer CS, Gabbe BJ, Cameron PA. Defining major trauma using the 2008 Abbreviated Injury Scale. Injury. 2016;47(1):109-115. doi:10.1016/j.injury.2015.07.003
Guerado E, Bertrand ML, Cano JR, Cerván AM, Galán A. Damage control orthopaedics: State of the art. World J Orthop. 2019;10(1):1-13. doi:10.5312/wjo.v10.i1.1
Dezman ZDW, Comer AC, Smith GS, Narayan M, Scalea TM, Hirshon JM. Failure to clear elevated lactate predicts 24-hour mortality in trauma patients. Journal of Trauma and Acute Care Surgery. 2015;79(4):580-585. doi:10.1097/TA.0000000000000810
Pape HC, Andruszkow H, Pfeifer R, Hildebrand F, Barkatali BM. Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery. Injury. 2016;47(4):787-791. doi:10.1016/j.injury.2016.03.020
Giannoudis PV, Giannoudis VP, Horwitz DS. Time to think outside the box: ‘Prompt-Individualised-Safe Management’ (PR.I.S.M.) should prevail in patients with multiple injuries. Injury. 2017;48(7):1279-1282. doi:10.1016/j.injury.2017.05.026
