Case ReportHemodynamic Deterioration in Lateral Compression Pelvic Fracture After Prehospital Pelvic Circumferential Compression Device Application
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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Cited by (8)
Management of open pelvic ring injuries
2023, InjuryPotentially serious adverse effects from application of a circumferential compression device for pelvic fracture: A report of three cases
2020, Trauma Case ReportsCitation 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, InjuryCitation Excerpt :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].
Application of pelvic circumferential compression devices in pelvic ring fractures—are guidelines followed in daily practice?
2021, Journal of Clinical MedicineThe Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures
2020, Frontiers in Surgery