Elsevier

Air Medical Journal

Volume 36, Issue 5, September–October 2017, Pages 272-274
Air Medical Journal

Case Report
Hemodynamic Deterioration in Lateral Compression Pelvic Fracture After Prehospital Pelvic Circumferential Compression Device Application

https://doi.org/10.1016/j.amj.2017.05.006Get rights and content

Abstract

Increased fracture displacement has previously been described with the application of pelvic circumferential compression devices (PCCDs) in patients with lateral compression–type pelvic fracture. We describe the first reported case of hemodynamic deterioration temporally associated with the prehospital application of a PCCD in a patient with a complex acetabular fracture with medial displacement of the femoral head. Active hemorrhage from a site adjacent to the acetabular fracture was subsequently demonstrated on angiography. Caution in the application of PCCDs to patients with lateral compression–type fractures is warranted.

Section snippets

Case Report

A 62-year-old man with end-stage renal failure was the front seat occupant of a vehicle that was struck by another vehicle at moderate speed directly into the patient's door, trapping him in the vehicle. The Glasgow Coma Scale (GCS) was initially 14, and the patient complained of pain in the right hip and chest. The initial observations by the responding physician helicopter emergency medical service team were recorded as a GCS of 14 (E4, M6, V4), heart rate of 95 beats/min, respiratory rate of

Discussion

Increased anatomic displacement of lateral compression–type pelvic ring fractures with application of a PCCD has previously been described in both cadaver models3 and in trauma patients4 although there are no previous reports of associated hemodynamic deterioration. Although temporally related, it is not possible to definitively demonstrate that the hemodynamic deterioration in this case was caused by the application of the PCCD, and other sites of hemorrhage were present with a hemothorax and

Conclusion

We report a case of significant hemodynamic deterioration associated with prehospital PCCD application in a patient with a lateral compression fracture. Ideally, PCCDs would be applied only to patients with fracture types that are likely to benefit. Further research is required to investigate modalities such as ultrasound that are both pragmatic for use in the prehospital environment and can be used to triage cases for suitability for PCCD application.

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  • Potentially serious adverse effects from application of a circumferential compression device for pelvic fracture: A report of three cases

    2020, Trauma Case Reports
    Citation Excerpt :

    While the nature, severity, and rates of PCCD-related complications remain unknown, skin blisters or breakdown on prolonged application, worsened sacral nerve root injury, and pelvic visceral injury have been described [12]. However, few reports regarding the detailed features of complications and clinical courses of patients have been published [7,13,14]. The present report describes initial management and complications confirmed radiographically.

  • Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients

    2020, Injury
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    Though effective, the placement of PCCDs has the potential to cause adverse outcomes including low-pressure necrosis to underlying soft tissue. [18,21–24] In the acute stage, a tightly placed PPCD could lead to worsening of lateral compression fracture patterns [25,26] with potential for damage to underlying structures including vessels, bowel, bladder and sacral nerve roots [27]. In addition, the routine placement of PCCDs is associated with a cost ranging between $87USD to $134USD for two market-leading devices [28–30].

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