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      Pelvic trauma: WSES classification and guidelines

      review-article
      1 , , 2 , 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 11 , 12 , 13 , 14 , 1 , 1 , 15 , 1 , 1 , 1 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 1
      World Journal of Emergency Surgery : WJES
      BioMed Central
      Pelvic, Trauma, Management, Guidelines, Mechanic, Injury, Angiography, REBOA, ABO, Preperitoneal pelvic packing, External fixation, Internal fixation, X-ray, Pelvic ring fractures

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          Abstract

          Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

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          Most cited references118

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          Management of bleeding following major trauma: an updated European guideline

          Introduction Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. Methods The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. Results Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. Conclusions This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.
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            Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST).

            Thoracic ultrasound (EFAST) has shown promise in inferring the presence of post-traumatic pneumothoraces (PTXs) and may have a particular value in identifying occult pneumothoraces (OPTXs) missed by the AP supine chest radiograph (CXR). However, the diagnostic utility of hand-held US has not been previously evaluated in this role. Thoracic US examinations were performed during the initial resuscitation of injured patients at a provincial trauma referral center. A high frequency linear transducer and a 2.4 kg US attached to a video-recorder were used. Real-time EFAST examinations for PTXs were blindly compared with the subsequent results of CXRs, a composite standard (CXR, chest and abdominal CT scans, clinical course, and invasive interventions), and a CT gold standard (CT only). Charts were reviewed for in-hospital outcomes and follow-up. There were 225 eligible patients (207 blunt, 18 penetrating); 17 were excluded from the US examination because of battery failure or a lost probe. Sixty-five (65) PTXs were detected in 52 patients (22% of patients), 41 (63%) being occult to CXR in 33 patients (14.2% whole population, 24.6% of those with a CT). The US and CXR agreed in 186 (89.4%) of patients, EFAST was better in 16 (7.7%), and CXR better in 6 (2.9%). Compared with the composite standard, the sensitivity of EFAST was 58.9% with a likelihood ratio of a positive test (LR+) of 69.7 and a specificity of 99.1%. Comparing EFAST directly to CXR, by looking at each of 266 lung fields with the benefit of the CT gold standard, the EFAST showed higher sensitivity over CXR (48.8% versus 20.9%). Both exams had a very high specificity (99.6% and 98.7%), and very predictive LR+ (46.7 and 36.3). EFAST has comparable specificity to CXR but is more sensitive for the detection of OPTXs after trauma. Positive EFAST findings should be addressed either clinically or with CT depending on hemodynamic stability. CT should be used if detection of all PTXs is desired.
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              Pelvic ring disruptions: effective classification system and treatment protocols.

              From January 1, 1985, to September 10, 1988, 210 consecutive patients with high-energy pelvic ring disruptions (exclusive of acetabular fractures) were admitted to a statewide referral center for adult multiple trauma. They were treated by one of four attending orthopaedic traumatologists per protocol as determined by their injury classification and hemodynamic status; the injury classification system was based on the vector of force involved and the quantification of disruption from that force, i.e., lateral compression, anteroposterior compression, vertical shear, and combined mechanical injury. Of the 210 patients, 162 had complete charts: 126 (78.0%) were admitted directly from the scene, 110 (67.9%) were injured in motor vehicle or motorcycle accidents, 25 (15.0%) were admitted in shock (blood pressure less than 90 mm Hg), the average Glasgow Coma Score was 13.2, and the average Injury Severity Score was 25.8. Treatment of the pelvic fracture included the following methods (alone or in combination): acute external fixation (45.0; 28.0%), open reduction/internal fixation (22; 13.5%), acute arterial embolization (11; 7.0%), and bedrest (68; 42.0%). Overall blood replacement averaged 5.9 units (lateral compression, 3.6 units; anteroposterior compression, 14.8 units; vertical shear, 9.2 units; combined mechanical, 8.5 units). Overall mortality was 8.6% (lateral compression, 7.0%; anteroposterior, 20.0%, vertical shear, 0%; combined mechanical, 18.0%). The cause of death was associated with the pelvic fracture in less than 50%; no patient with an isolated or vertical shear pelvic injury died. We conclude that the predictive value of our classification system (incorporating appreciation of the causative forces and resulting injury patterns) and our classification-based treatment protocols reduce the morbidity and mortality related to pelvic ring disruption.
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                Author and article information

                Contributors
                +39-035-2673477 , federico.coccolini@gmail.com
                philip.stahel@dhha.org
                giulia.montori@gmail.com
                Wbiffl@queens.org
                tal.horer@regionorebrolan.se
                faustocatena@gmail.com
                y_kluger@rambam.health.gov.il
                Ernest.Moore@dhha.org
                peitzmanab@upmc.edu
                raoivatury@gmail.com
                rcoimbra@ucsd.edu
                fragagp2008@gmail.com
                drbrunompereira@gmail.com
                rizolis@smh.ca
                andrew.kirkpatrick@albertahealthservices.ca
                Ari.Leppaniemi@hus.fi
                Rmanfredi@asst-pg23.it
                smagnone@asst-pg23.it
                ochiara@yahoo.com
                leonardosolaini@gmail.com
                marco.ceresoli89@gmail.com
                niccolo.allievi@gmail.com
                CArvieux@chu-grenoble.fr
                gvelmahos@partners.org
                Zsolt.Balogh@hnehealth.nsw.gov.au
                noel.naidoo@gmail.com
                dietergweber@gmail.com
                fabuzidan@uaeu.ac.ae
                Massimosartelli@gmail.com
                lansaloni@asst-pg23.it
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                1749-7922
                18 January 2017
                18 January 2017
                2017
                : 12
                : 5
                Affiliations
                [1 ]ISNI 0000 0004 1757 8431, GRID grid.460094.f, General, Emergency and Trauma Surgery, , Papa Giovanni XXIII Hospital, ; P.zza OMS 1, 24128 Bergamo, Italy
                [2 ]ISNI 0000000107903411, GRID grid.241116.1, Department of Orthopedic Surgery and Department of Neurosurgery, , Denver Health Medical Center and University of Colorado School of Medicine, ; Denver, CO USA
                [3 ]GRID grid.415594.8, Acute Care Surgery, , The Queen’s Medical Center, ; Honolulu, HI USA
                [4 ]ISNI 0000 0001 0738 8966, GRID grid.15895.30, , Dept. of Cardiothoracic and Vascular Surgery & Dept. Of Surgery Örebro University Hospital and Örebro University, ; Örebro, Sweden
                [5 ]Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
                [6 ]Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel
                [7 ]ISNI 0000 0001 0369 638X, GRID grid.239638.5, , Trauma Surgery, Denver Health, ; Denver, CO USA
                [8 ]ISNI 0000 0004 1936 9000, GRID grid.21925.3d, Surgery Department, , University of Pittsburgh, ; Pittsburgh, Pensylvania USA
                [9 ]ISNI 0000 0004 0458 8737, GRID grid.224260.0, , Virginia Commonwealth University, ; Richmond, VA USA
                [10 ]GRID grid.420234.3, Department of Surgery, , UC San Diego Health System, ; San Diego, USA
                [11 ]ISNI 0000 0001 0723 2494, GRID grid.411087.b, , Faculdade de Ciências Médicas (FCM) – Unicamp, ; Campinas, SP Brazil
                [12 ]GRID grid.415502.7, Trauma & Acute Care Service, , St Michael’s Hospital, ; Toronto, ON Canada
                [13 ]ISNI 0000 0004 0469 2139, GRID grid.414959.4, , General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery Foothills Medical Centre, ; Calgary, AB Canada
                [14 ]Abdominal Center, University Hospital Meilahti, Helsinki, Finland
                [15 ]GRID grid.416200.1, Emergency and Trauma Surgery, , Niguarda Hospital, ; Milan, Italy
                [16 ]GRID grid.450307.5, Digestive and Emergency Surgery, , UGA-Université Grenoble Alpes, ; Grenoble, France
                [17 ]ISNI 000000041936754X, GRID grid.38142.3c, , Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, ; Boston, MA USA
                [18 ]ISNI 0000 0004 0577 6676, GRID grid.414724.0, Department of Traumatology, , John Hunter Hospital and University of Newcastle, ; Newcastle, NSW Australia
                [19 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, Department of Surgery, , University of KwaZulu-Natal, ; Durban, South Africa
                [20 ]ISNI 0000 0004 0453 3875, GRID grid.416195.e, Department of General Surgery, , Royal Perth Hospital, ; Perth, Australia
                [21 ]ISNI 0000 0001 2193 6666, GRID grid.43519.3a, Department of Surgery, , College of Medicine and Health Sciences, UAE University, ; Al-Ain, United Arab Emirates
                [22 ]General and Emergency Surgery, Macerata Hospital, Macerata, Italy
                Article
                117
                10.1186/s13017-017-0117-6
                5241998
                28070213
                0cb6ac87-d556-467c-ac8e-14a73e464916
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 December 2016
                : 12 January 2017
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Surgery
                pelvic,trauma,management,guidelines,mechanic,injury,angiography,reboa,abo,preperitoneal pelvic packing,external fixation,internal fixation,x-ray,pelvic ring fractures

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