Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Clinical and epidemiological features of pelvic fractures presenting to the emergency department in a tertiary health care hospital in south India:A retrospective study

Objective:To determine the clinical and epidemiological features of pelvic fracture patients presenting to the Emergency Department.Methods:This prospective observational study was conducted in a tertiary care center in south India.Causes of injury,types of pelvic fractures,the associated injuries,and outcome at the time of discharge were recorded.Results:A total of 140 patients were included in this study.Most patients were classified as type A(n=62),followed by type B(n=48)and type C(n=30).A total of 112 patients were injured due to road traffic accidents,followed by a fall from a height(n=23)and a fall from a heavy object(n=5).Most subjects had facial injuries(n=99,70.7%),followed by head injuries(n=51,36.4%).Five percent of the patients were expired,12%left against medical advice,and 83%were discharged.Conclusions:The incidence of pelvic fractures presenting to the Emergency Department is relatively high in India.Road traffic accidents are the primary cause of pelvic fractures and associated facial and head injuries.The outcomes demonstrate the need for improved prevention strategies and comprehensive management protocols to reduce mortality.

A Retrospective Analysis of the Patterns and Outcomes of Tile B and Tile C Pelvic Fractures in Cameroon

Background: Pelvic fractures constitute about 2% - 8% of all fractures. This incidence may rise up to 25% in poly-traumatised patients. These fractures have a high mortality rate due to the fact that they occur usually as a result of high energy trauma, and most of the injured are poly-traumatised with concomitant haemodynamic instability. The aim of this study is to describe the patterns of injury and complications of unstable pelvic fractures treated in a level III hospital in Cameroon. Methodology: This was a hospital based retrospective analysis of files of patients admitted and treated for unstable pelvic fractures at the Regional Hospital Limbe within a period of 10 years (from 1st of January 2009 to 31st of December 2018). Results: A total of 139 cases of pelvic fractures were identified, amongst which 77 were unstable;68 were finally analyzed. The ages ranged from 18 to 80 years with a mean of 39 ± 5 years. The age group from 20 - 40 years was most represented (58.88%, n = 40). There were 45 males and 23 females giving a sex-ratio of 2:1. Road traffic injuries accounted for most of the cases (73.53%, n = 50). Forty-five (66.2%) were classified Tile B and 23 (33.82%) were Tile C, and 15 cases were open fractures (22.06%). Associated lesions were recorded in 30 cases, fractures of the lower extremity being the most common (33.33%, n = 10). Most of the cases were definitively treated surgically (80.89%, n = 55). The most common complications were surgical site infections (23.64%, n = 13). Conclusion: Unstable pelvic fractures are relatively common. Young males in the age group 20 - 40 years are the most affected, and the most common cause of injury was road traffic accident. Surgical site infections, pressure ulcers, severe anaemia and thrombo-embolism are common complications.

Management of complex and redo cases of pelvic fracture urethral injuries

Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.

Treatment of posterior urethral distractions defects following pelvic fracture

Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

Open pelvic fractures associated with anorectal injuries:emergency management strategies and risk factors for mortality

Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fractures

Flap transplantation for treatment of pelvic fracture and defective hip

A case of flap transplantation for treatment of pelvic fracture and defective hip in the Third Affiliated Hospital of Inner Mongolia Medical University was collected and analyzed on the basis of diagnosis,physical examination and treatment.The patient was in serious condition with large necrotic area and prone to lead to various complications.The paper aims to share experience and provide references for similar cases amongst surgeons.

External fixator with lumbopelvic distraction spondylodesis for vertically unstable pelvic fracture

Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures.Methods From January 2008 to March 2009,9 patients(4 males and 5 females)

Internal iliac artery ligation as a damage control method in hemodynamically unstable pelvic fractures:A systematic review of the literature

Purpose:Internal iliac artery ligation(IIAL)has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years.However,there is ongoing debate regarding the effectiveness and safety of this hemostatic method.Therefore,we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis.Methods:Three major databases,PubMed,Embase,and Google Scholar,were searched to screen eligible original studies published in English journals.Two reviewers independently read the titles,abstracts,and full texts of all literature.Articles were included if they reported the use and effects of IIAL.Results:A total of 171 articles were initially identified,with 22 fully meeting the inclusion criteria.Among the analyzed cases,up to 66.7%of patients had associated abdominal and pelvic organ injuries,with the urethra being the most frequently injured organ,followed by the bowel.The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory,with an effective rate of 80%.Hemorrhagic shock was the leading cause of death,followed by craniocerebral injury.Notably,no reports of ischemic complications involving the pelvic organs due to IIAL were found.Conclusion:IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia.This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.

Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury

Objectives:To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury(PFUI)in patients with a history of failed anastomotic urethroplasty.Materials and methods:We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021.Patients with incomplete data and those who were lost to follow-up were excluded.Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention.Functional results,including erectile function and urinary continence,were evaluated.Descriptive statistical analyses were then performed.Results:Thirty-one patients were included in this study.Among them,concomitant urethrorectal fistula occurred in 2 patients,and concomitant enlarged bladder neck occurred in 1.The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29.The mean length of urethral stenosis in all patients was 3.1 cm(range,2.0-5.0 cm).After a mean follow-up of 34.6 months,the final success rate was 96.8%.The incidence of erectile dysfunction reached 77.4%(24/31).Normal continence was achieved in 27(87.1%)patients.One patient developed urinary incontinence of gradeⅡrequiring urinary pads because of an enlarged bladder neck.According to the Clavien-Dindo classification,postoperative complications of grade I occurred in 7 patients and gradeⅡin 4.Conclusions:Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI.In complicated cases,it should be known and mastered.

Preoperative virtual reduction method for pelvic fractures based on statistical shape models and partial surface data

Virtual reduction is crucial for successful and accurate reduction of pelvic fractures.Various methods have been proposed in this regard.However,not all of them are applicable to every pelvic fracture.Among these methods,the efficiency and accuracy of the method based on statistical shape models in clinical applications require further improvement.This study proposes a virtual reduction method for pelvic fractures that uses statistical shape models and partial surface data of a broken pelvis.Simulated fracture and clinical case experiments were conducted to validate the accuracy and effectiveness of the proposed method.The simulated fracture experiments yielded an average error of 1.57±0.39 mm and a maximum error of 12.82±3.54 mm.The virtual reduction procedure takes approximately 40 s.Based on three clinical case experiments,the proposed method achieves an acceptable level of accuracy compared with manual reduction by a surgeon.The proposed method offers the advantages of shorter virtual reduction times and satisfactory reduction accuracy.In the future,it will be integrated into the preoperative planning system for pelvic fracture reduction,thereby improving patient outcomes.

Study on the interactive deformation of bone needles and circum-pelvic soft tissue

During the robot-assisted pelvic fracture reduction,the needle-tissue interactive deformation characteristic is not clear,which affects the accuracy of robotic surgery.In this paper,a layered rig-id-flexible coupling model is proposed,and the needle-tissue interactive deformation under the load-ing is analyzed by the Rayleigh-Ritz method,in accordance with the principle of minimum potential energy.The pelvic musculoskeletal tissue is reversely reconstructed,and the structure of the bone is segmented into cancellous bone and cortical bone.The Mooney-Rivlin five-parameter hyperelastic model is used to simulate muscle,and the Ogden hyperelastic model is used to simulate adipose tis-sue.Finite element simulation is performed by loading different magnitudes of forces.The accuracy of the rigid-flexible coupling model is 0.432 mm,which indicates the correctness of the needle-tis-sue interactive deformation theory analysis.

External fixation in early treatment of unstable pelvic fractures

Background Patients with pelvic fractures are often treated in hospitals without the capacity to implement an open reduction internal fixation （ORIF）. This often leads to pelvic malunion in patients with unstable pelvic fracture, shock or even death due to uncontrollable pelvic hemorrhage and unstable hemodynamics. This study explored the role of early external fixation （within 7 days） for patients with unstable pelvic fractures. Methods A retrospective analysis was conducted on 32 patients with unstable pelvic fractures treated with early external fixation from January 2005 to January 2010 （Tile type B： 18 cases; C： 14 cases）. The study comprised 28 males and 4 females, with a mean age of （32_＋8） years （range, 21-56 years）. Of these patients, 22 were treated with emergency pelvic external fixation and 10 were treated with external fixation within 1-7 days. Fifteen cases suffered traumatic hemorrhagic shock. A statistical analysis was conducted to compare fluid infusion and blood transfusion volumes within the first 24 hours of these shock patients with another cohort of patients treated without early external fixation from January 1993 to January 1998. Results The average follow-up was （34.7_＋14.6） months （range, 6-66 months）. Six to eight weeks after external fixation, patients could walk with crutches; by 12 weeks, external fixation was removed and all fractures had healed. Seven patients presented with sequelae, including 3 patients with long-term lumbosacral pain, 3 patients with erectile dysfunction and 1 patient with MoreI-Lavallee lesion and other complications. The 15 shock patients in this study （2005-2010 group） required significantly lower volumes of fluid infusion and blood transfusion （Pfluid=0.000; mtransfusion=0.000） as compared to the 1993-1998 cohort. Conclusions The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability, with outstanding efficacy as a final fixation option for unstable pelvic fractures.

Effect of early restrictive fluid resuscitation on inflammatory and immune factors in patients with severe pelvic fracture

Purpose:To study the effect of early restrictive fluid resuscitation(EFR)on inflammatory and immune factors in patients with severe pelvic fracture(SPF).Methods:A total of 174 SPF patients in the Department of Orthopaedics,the First Affiliated Hospital of Chengdu Medical College from July 2015 to June 2018 were involved in this study and divided into EFR group(n=87)and control group(n=87)using the random number table method.Conventional fluid resuscitation(CFR)was performed in control group,and EFR was performed in EFR group.The incidences of acute respiratory distress syndrome(ARDS)and multiple organ dysfunction syndrome(MODS)during rescue,successful rescue rate,blood transfusion volume,fluid input,and resuscitation time were compared between the two groups.The parameters including prothrombin time(PT),hematocrit(HCT),platelet(PLT)and blood lactate(BL)at the 4th hour after fluid resuscitation were recorded.The levels of inflammatory factors(TNF-α,IL-6,CRP)and immune factors(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)were compared between the two groups before treatment and 7 days after treatment.The revised acute physiologic and chronic health evaluation system and the sequential organ failure assessment scores were adopted for evaluation before treatment and 7 days after treatment.Results:The incidences of ARDS and MODS during rescue in EFR group were significantly lower than those in control group(p=0.015 and 0.010 respectively),and the successful rescue rate in EFR group was significantly higher than that in control group(p=0.011).The blood transfusion volume,fluid input,resuscitation time in EFR group were significantly lower than those in control group(p=0.016,0.002 and 0.001 respectively).At the 4th hour after fluid resuscitation,PT and BL in EFR group were significantly lower than those in control group(p=0.021 and 0.003 respectively),while HCT and PLT in EFR group were significantly higher than those in control group(p=0.016 and 0.021 respectively).On day 7 after treatment,TNF-α,IL-6,CRP and CD8^+in EFR group were significantly lower than those in control group(p=0.003,0.004,0.007 and 0.003 respectively),while CD3^+,CD4^+and CD4^+/CD8^+in EFR group were significantly higher than those in control group(p=0.004,0.000,0.007 respectively).On day 7 after treatment,the revised acute physiologic and chronic health evaluation(APACHE)system and the sequential organ failure assessment(SOFA)scores in EFR group were significantly lower than those in control group.Conclusion:EFR can effectively eliminate inflammatory factors,improve immune function,maintain the stability of blood components,reduce the incidences of ARDS and MODS,and elevate the successful rescue rate in patients with SPF.

Management and outcome of pelvic fractures in elderly patients： a retrospective study of 40 cases

Background Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature.The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.Methods We retrospectively reviewed the records of pelvic fractures in elderly patients （age ≥55 years） who were treated in our department from September 1997 to May 2010.Results A total of 40 elderly patients with pelvic fractures were identified.Their mean age was 65.8 years （range 55-87 years）.About 68% （n=27） were men.The average Injury Severity Score （ISS） was 17.8 （range 6-45）.Twelve （30%）patients required blood transfusion （mean 10 units） during the first 24 hours.The fractures were most frequently due to falling from a standing position （48%）.Almost half （48%） were grade I breaks.Associated injuries were present in 70%（n=28） of patients,and 65% （n=26） had medical co-morbidities.Altogether,29 patients （73%） underwent non-surgical management of their pelvic fracture.The average hospital stay was 25 days.There were five in-hospital deaths and one death 10 months after discharge.High ISSs （〉25） were associated with increased in-hospital mortality （P=0.018）.At the final assessment （mean follow-up 15 months）,52% of the surviving patients had experienced decreased self-sufficiency.Conclusions Pelvic fractures in elderly patients result in high morbidity and mortality rates.A high ISS （〉25） can be used to identify a patient at high risk.We recommend aggressive resuscitation and intensive care for that patient.For patients with an unstable pelvic or displaced acetabular fracture （≥2 mm） who can endure surgery,open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.

Surgical hemostatic options for damage control of pelvic fractures

The diagnosis and treatment of pelvic ring disruption has significantly changed over the past 30 years.It was not until the 1980s that the concept of damage control surgery was applied in the management of severely traumatized patients.The contents of damage control surgery mainly include three phases：the initial stage,the goal of severe pelvic trauma treatment is using simple surgical techniques to control life-threatening bleeding;the second stage,the physiological disturbances of the patients were corrected by ICU resuscitation;and the third stage,the definitive surgery performed for the injuries.1 About 10% to 20% of patients with severe unstable pelvic fracture also present with hemodynamic instability,and the mortality rate of them can be as high as 40%.2-4 Although hemodynamic resuscitation techniques have made great progress,some patients do not respond or poorly respond to resuscitation treatment.

The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures

Purpose:Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality.This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.Methods:This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019.All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study.The indication was persistent systolic blood pressure90 mmHg during initial resuscitation and after transfusion of two units of red blood cells.Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded.Their demographic characteristics,clinical features,laboratory results,therapeutic interventions,adverse events,and prognostic outcomes were collected from digital information system of electronic medical records.Statistics were described as mean±standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.Results:The patients’average age was 41.6 years,ranging from 10 to 88 years.Among them,45 cases were male(67.2%)and 22 cases were female(32.8%).Significant difference was found regarding the systolic blood pressure(mmHg)in the emergency department(78.4±13.9)and after preperitoneal pelvic packing in the surgery intensive care unit(100.1±17.6)(p<0.05).Simultaneously,the arterial base deficit(mmol/L)were significantly lower in the surgery intensive care unit(median-6,interquartile range-8 to-2)than in the emergency department(median-10,interquartile range-14 to-8)(p<0.05).After preperitoneal pelvic packing,15 patients(22.4%)underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage.The overall mortality rate was 29.5%(20 of 67).Conclusions:Preperitoneal pelvic packing,as a useful surgical technique,is less invasive and can be very efficient in early intra-pelvic bleed control.

Stabilization of unstable pelvic fractures with a novel internal-external fixator

An internal-external fixator for stabilization in three cases with unstable pelvic fractures were reported. Compared with external fixation, the internal-external fixator, which is placed in the subcutaneous layer, decreased the risk of pin-track infection, pin site pain, and bowel obstruction; meanwhile, it had the advantage of external fixation： it was easy to apply, controlled damage, and resulted in minimal injury.