Skip to main content
SpringerLink
Log in

Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine.

Methods

We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures. Data were collected anonymously via a standardized case report.

Results

A total of 254 patients with suspected pelvic injuries from 12 different trauma centers were included in this study. In 95 out of 254 cases a per definition unstable pelvic fracture could be confirmed; 46 type B and 49 type C fractures was confirmed. Mechanical stability examination was carried out in 61% and revealed a sensitivity of 31.6% and a specificity of 92.2%. 11.5% (18 patients) actually showed a mechanical instability (6 B# 12 C#). Regardless, 166 patients (65.4%) received noninvasive external stabilization ahead of diagnostic imaging, as a result of clinical judgment. 72% (24×) showed signs of significant bleeding in the subsequent CT scans. 33 pelvic ring fractures (type B or C) had no prehospital stabilization.

Conclusion

Testing of mechanical stability of the pelvic ring was carried out less often and with lower consequences for the actual management than expected. It seems worthwhile to rather put on a pelvic binder at earliest occasion based on trauma mechanism or clinical findings to reduce the risk of serious pelvic bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lefering R, Paffrath T. Sektion Notfall- Intensivmedzin und Schwerverletztenversorgung (NIS) der DGU: TraumaRegister DGU/TraumaRegisterQM DGU Jahresbericht 2012;2012.

  2. Manson T, O’Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J. Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 2010;24:603–9.

    Article  Google Scholar 

  3. Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, Borer DS, Rao AV, Jones AL. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma. 2002;16:553–61.

    Article  Google Scholar 

  4. Bonner TJ, Eardley WG, Newell N, et al. Accurate placement of a pelvic binder improves reduction of unstable fractures in the pelvic ring. J Bone Jt Surg Br. 2011;93-B:1524–8.

    Article  Google Scholar 

  5. Spanjersberg WR, Knops SP, Schep NW, et al. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009;40:1031–5.

    Article  Google Scholar 

  6. Tan EC, van Stigt S, van Vugt A. Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury. 2010;41:1239–43.

    Article  Google Scholar 

  7. NAEMT, Herausgeber. Präklinisches Traumamanagement, Prehospital Trauma Life Support (PHTLS), 2. Aktualisierte und überarbeitete Auflage. Elsevier GmbH, Munich, 2012.

  8. American College of Surgeons Committee on Trauma. Abdominal and pelvic trauma. In: American College of Surgeons, editor. ATLS student course manual. 9th ed. Chicago: American College of Surgeons; 2012. pp. 122–140.

  9. Grant PT. The diagnosis of pelvic fractures by ‘springing’. Arch Emerg Med. 1990;7(3):178–82.

    Article  Google Scholar 

  10. Pehle B, Nast-Kolb D, Oberbeck R, et al. Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room. Unfallchirurg. 2003;106(8):642–8.

    Article  Google Scholar 

  11. Shlamovitz GZ, Mower WR, Bergman J, et al. How (un)useful is the pelvic ring stability examination in diagnosing mechanically unstable pelvic fractures in blunt trauma patients? J Trauma. 2009;66(3):815–20.

    Article  Google Scholar 

  12. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF) (2016): S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. Deutsche Gesellschaft für Unfallchirurgie (Hrsg), AWMF-Register Nr. 012/019. http://www.awmf.org/leitlinien/detail/ll/012-019.html. Zugegriffen 29.06.2017.

  13. McCormack R, Strauss EJ, Alwattar BJ, et al. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis. 2010;68:281–91.

    PubMed  Google Scholar 

  14. Pohlemann T, Tscherne H, Baumgärtel F, et al. Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg. 1996;99:160–7.

    Article  CAS  Google Scholar 

  15. Siegmeth A, Müllner Th, Kukla Ch, et al: Begleitverletzungen beim schweren Beckentrauma. Unfallchirurg. 2000;103:572–81.

    Article  CAS  Google Scholar 

  16. Eastridge BJ, Starr A, Minei JP, et al. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–51.

    Article  Google Scholar 

  17. Smith WR, Moore EE, Osborn P, et al: Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representive cases and a description of technique. J Trauma 2005; 59:1510–1514.

    Article  Google Scholar 

  18. Fu CY, Wu SC, Chen RJ, et al. Evaluation of pelvic fractures stability and the need for angioembolisation: pelvic instabilities on plain film have an increased probability of requiring angioembolisation. Am J Emerg Med. 2009;27:792–6.

    Article  Google Scholar 

  19. Scalea T, O’Toole R. Pelvic fractures. In: Felicano D, Mattox K, Moore E, editors. Trauma. 6th ed. New York City: McGraw-Hill. 2008. p. 783 (Cap. 38).

  20. Wohlrath B, Trentzsch H, Hoffmann R, et al. Präklinische und klinische Versorgung der instabilen Beckenverletzung-Ergebnisse einer Online-Umfrage; Unfallchirurg 2016, 119; pp. 755–62.

    Article  Google Scholar 

  21. Pohlemann T, Tscherne H, editors: Becken und Acetabulum. Tscherne Unfallchirurgie in 13 Bänden. Springer, Berlin, 1998

  22. Deutsche Gesellschaft für Unfallchirurgie (DGU). Sektion Intensiv- & Notfallmedizin, Schwerverletztenversorgung (NIS) und AUC - Akademie der Unfallchirurgie GmbH, DGU Traumaregister Jahresbericht 2015. http://www.traumaregister-dgu.de/Downloads/TR-DGU-Jahresbericht_22.7.2017.

  23. Schweigkofler U, Wohlrath B, Paffrath T, et al. Recommendations for releasing the pelvic binder after a non-invasive pelvic stabilisation procedure under emergency room conditions. Z Orthop Unfall. 2016;154(5):470–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstraße 430, 60389, Frankfurt, Germany

    Uwe Schweigkofler, B. Wohlrath, N. Tamimi, R. Hoffmann & D. Wincheringer

  2. Institut für Notfallmedizin und Medizinmanagement, Schillerstr 53, 80336, Munich, Germany

    H. Trentsch

  3. Abt. für Orthopädie & Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscherstr.8, 82418, Murnau, Germany

    J. Greipel

Authors
  1. Uwe Schweigkofler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Wohlrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Trentsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Greipel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Tamimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Wincheringer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Uwe Schweigkofler.

Ethics declarations

Conflict of interest

All authors (Schweigkofler, Wohlrath, Trentzsch, Greipel, Tamimi, Hoffmann and Wincheringer) declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schweigkofler, U., Wohlrath, B., Trentsch, H. et al. Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. Eur J Trauma Emerg Surg 44, 747–752 (2018). https://doi.org/10.1007/s00068-017-0860-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-017-0860-0

Keywords

Search

Navigation