Mortality Risk in Polytrauma Patients with Pelvic Injury
Authors:
Grill R.ihash2ihash4ihash6ihash8ihash10ihash12 1+2 1+3 1+4 1+5 1+3 1+6 1+4
Authors place of work:
Centrum pro integrované studium pánve 3. LF UK, Praha, vedoucí lékař: MUDr. Robert Grill, Ph. D.
1; Urologická klinika 3. LF UK a FNKV, Praha, přednosta: doc. MUDr. Michal Urban, CSc.
2; Klinika anestezie a resuscitace 3. LF UK a FNKV, Praha, přednosta: prof. MUDr. Jan Pachl, CSc.
3; Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha, přednosta: doc. MUDr. Martin Krbec, CSc. 5Traumatologická klinika Úrazové nemocnice, Brno, přednosta: prof. MUDr. Peter Wendsche, CSc.
4; Ústav anatomie 3. LF UK, Praha, přednosta: prof. MUDr. Josef Stingl, DrSc.
6
Published in the journal:
Rozhl. Chir., 2009, roč. 88, č. 2, s. 75-78.
Category:
Monothematic special - Original
Summary
The aim of the study is to present results showing whether a pelvic injury in polytrauma patients means a high risk of mortality. The retrospective study (January 2001 – December 2006) included 453 polytrauma patients (130 women, 323 men) with ISS exceeding 16 points, hospitalized at the authors’ department (Traumacentre Level I). The age of patients ranged between 13–93 years, the mean age of the whole group was 41 years (43 years in women, 40 years in men). The highest percentage of the deceased was recorded in the subgroup with abdominal injury (35%) and in the subgroup with pelvic injury (31%), the lowest in the subgroup without abdominal injury (20%). A significant difference was recorded between the numbers of deceased patients with and without abdominal trauma (p < 0.001), and between the numbers of patients with and without pelvic injury (p = 0.046). The results of the study have demonstrated a significantly higher rate of mortality in polytrauma patients with ISS > 16 points, with a simultaneous pelvic injury as compared to the patients without pelvic injury.
Key words:
pelvic injury – mortality risk – polytrauma
Zdroje
1. Burkhadt, M., Culemann, U., Seekamp, A., Pohlemann, T. Operative Versordungsstrategien beim Polytrauma mit Beckenfraktur. Eine Literaturübersicht. Unfallchirurg, 2005, 108, 812–820.
2. Chong, K., DeCoster, T., Osler, T., Robinson, B. Pelvic fractures and mortality. Iowa Orthop. J., 1997, 17, 110–114.
3. Culemann, U., Tosounidis, G., Reilmann, H., Pohlemann, T. Beckenringverletzung. Diagnostik und aktuelle Behandlungsmöglichkeiten. Chirurg, 2003, 74, 687–700.
4. Demetriades, D., Karaiskakis, M., Toutouzas, K., Alo, K., Velmahos, G., Chan, L. Pelvic fractures: Epidemiology and predictors of associated abdominal injuries and outcomes. J. Am. Coll. Surg., 2002, 195, 1–10.
5. Eastridge, B. J., Starr, A., Minei, J.P., O‘Keefe, G. E. The importance of fracture pattern inguiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J. Trauma, 2002, 53, 446–451.
6. Gänsslen, A., Hüfner, T., Krettek, C. Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy. Oper. Orthop. Traumatol., 2006, 18, 225–244.
7. Giannoudis, P. V., Pape, H. C. Damage control orthopedics in unstable pelvic ring injuries. Injury, 2004, 35, 671–677.
8. Grotz, M.R., Allami, M.K., Harwood, P., Pape, H.C., Krettek, C., Giannuodis, P.V. Open pelvic fractures: Epidemiology, current concepts of management and outomes. Injury, 2005, 36, 1–13.
9. Ismail, N., Bellemare, J. F., Mollitt, D. L., DiScala, C., Koeppel, B.,Tepas, J. J. Death from pelvic fracture: Childern are different. J. Pediatr. Surg., 1996, 31, 82–85.
10. John, T., Ertel, W. Die Beckenringzerreißung beim polytraumatisierten Patienten. Orthopäde, 2005, 34, 917–930.
11. Keel, M., Trentz, O. Polytrauma management. Early total care versus damage control. AO Dialogue, 2005, 18, 24–27.
12. Krieg, J. C., Mohr, M., Ellis, T. J., Simpson, T. S., Madey, S. M., Bottlang, M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: A clinical trial. J. Trauma, 2005, 59, 659–664.
13. Lunsjo, K., Tadros, A., Hauggaard, A., Blomgren, R., Kopke, J., Abu-Zidan, F.M. Associated injuries and not fracture instability predict mortality in pelvic fractures: A prospective study of 100 patients. J Trauma, 2007, 62, 687–691.
14. Mirza, A., Ellis, T. Initial management of pelvic and femoral fractures in the multiply injured patient. Crit. Care. Clin., 2004, 20, 159–170.
15. Mohanty, K., Musso, D., Powell, J. N., Kortbeek, J. B., Kirkpatrick, A. W. Emergent management of pelvic ring injuries: An update. Can. J. Surg., 2005, 48, 49–56.
16. Nerlich, M., Maghsudi, M. Algorithms for early management of pelvic fractures. Injury, 1996, 27 (Suppl. 1), 29–37.
17. Olson, S.A., Rhorer, A.S. Orthopaedic trauma for the general orthopaedist: avoiding problems and pitfalls in treatment. Clin. Orthop., 2005: 433, 30–37.
18. O’Sullivan, R. E., White, T. O., Keating, J. E. Major pelvic fractures: Identification of patients high risk. J. Bone Jt Surg. Br., 2005, 87-B, 530–533.
19. Pavelka, T., Džupa, V., Štulík, J., Grill, R., Báča, V., Skála-Rosenbaum, J. Výsledky operační léčby nestabilního poranění pánevního kruhu. Acta Chir. Orthop. Traumatol. Čech., 2007, 74, 19–28.
20. Pohlemann, T., CulemanN, U., Tosounidis, G., Kristen, A. Die Anlage der Notfall-Beckenzwinge. Unfallchirurg, 2004, 107, 1185–1191.
21. Pryor, J. P., Reilly, P. M. Initial care of the patient with blunt polytrauma. Clin. Orthop., 2004, 422, 30–36.
22. Richter, M., Otte, D., Gänsslen, A., Bartram, H., Pohlemann, T. Injuries of the pelvic ring in road traffic accidents: A medical and technical analysis. Injury, 2001, 32, 123–128.
23. Rieger, H., Joosten, U., Probst, A., Joist, A. Zur Bedeutung von Score-System beim offenen Komplextrauma des Beckens. Zentralbl. Chir., 1999, 124, 1004–1010.
24. Rommens, P. M., Hessman, M. H. Staged reconstruction of pelvic ring disruption: Defferences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C – type lesions. J. Orthop. Trauma, 2002, 16, 92–98.
25. Routt, M. L., Falicov, A., Woodhouse, E., Schildhauer, T. A. Circumferential pelvic antishock sheeting: A temporary resuscitation aid. J. Orthop. Trauma, 2002, 16, 45–48.
26. Ruchholz, S., Waydhas, C., Lewan, U., Pehle, B., Taeger, G., Kühne, C., Nast-Kolb, D. Free abdominal fluid on ultrasound in unstable pelvic ring fracture: Is laparotomy always necessary? J. Trauma, 2006, 57, 278–287.
27. Sadri, H., Nguyen-Tang, T., Stern, R., Hoffmeyer, P., Peter, R. Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption. Arch. Orthop. Trauma Surg., 2005, 125, 443–447.
28. Schmal, H., Markmiller, M., Mehlhorn, A. T., Sudkamp, N. P. Epidemiology and outcome of complex pelvic injury. Acta Orthop. Belg., 2005, 71, 41–47.
29. Siegmeth, A., Müllner, T., Kukla, C., Vécsei, V. Begleitverletzungen beim schweren Beckentrauma. Unfallchirurg, 2000, 103, 572–581.
30. Smith, W., Willims, A., Agudelo, J., Shannon, M., Morgan, S., Stahel, P., Moore, E. Early predictors of mortality in hemodynamically unstable pelvis fractures. J. Orthop. Trauma, 2007, 21, 31–37.
31. Starr, A.J., Griffin, D.R., Reinert, C.M., Frawley, W.H., Walker, J., Whitlock, S.N., Borer, D.S., Rao, A.V., Jones, A.L. Pelvic ring disruption: Prediction of associated injuries, transfusion requirenet, pelvic arteriography, comlications, and mortality. J. Orthop. Trauma, 2002, 16, 553–561.
32. Tille, M., Helfet, D. L., Kellam, J. F. (Eds) Fractures of the pelvis and acetabulum. 3rd edition. Philadelphia: Lippincott Williams & Wilkins, 2003, 830.
33. Tscherne, H., Pohlemann, T., Gänsslen, A. Klasifikation, Einstufung, Dringlichkeit und Indikation bei Beckenverletztungen. Zentralbl. Chir., 2000, 125, 717–724.
34. van Vugt, A. B., van Kampen, A. An unstable pelvic ring. The killing fracture. J. Bone Jt Surg. Br., 2006, 88-B, 427–433.
35. Vermeulen, B., Peter, R., Hoffmeyer, P., Unger, P.-F. Prehospital stabilization of pelvic dislocations: A new strap belt to provide temporary hemodynamic stabilization. Swiss Surg., 1999, 5, 43–46.
36. Westhoff, J., Höll, S., Kälicke, T., Muhr, G., Kutscha-Lissberg, F. Die offene Beckenfraktur. Behandlungsstrategie und Resultate anhand von 12 Patienten. Unfallchirurg, 2004, 107: 189–195.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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