Early Management of Bleeding Complications in Pelvic Ring Injuries – What can we learn from the German Pelvis Registry?
Authors: Metzger F. , Höch A. , Herath S. C. , Buschbeck S. , Huber S.F. , Schweigkofler U. 
Published: November 2024

Abstract

Background/Purpose:
About 9% of the pelvic ring injuries (PRI) are considered partially unstable or unstable (Tile type B and C) and can cause massive hemorrhage. Their prehospital detection and accurate management are highly relevant. Pelvic circumferential compression devices (PCCD) became an indispensable tool in the early management. Measuring their beneficial effects seems difficult. To complement on preexisting data, this retrospective cohort study from the German Pelvis Registry aims to answer several questions concerning partially- and unstable PRI with bleeding complications (BC).
Methods:
Inclusion criteria: Partially unstable and unstable PRI in adults (age > = 17 and < = 64 years) (n = 335) and presence of a BC (n = 133, 39,7%) in closed cases in the TraumaRegister DGU® and the German Pelvis Registry between 07/2018 and 02/2023. Exclusion criteria: Acetabular fractures and combinations, age < 17 and > 64 years, inter-hospital transfers.
Results:
The majority of PJI occurred in traffic accidents and from falls above 3m height. A BC was identified in 30,7% with a Tile type B and 49,7% with a Tile type C injury. Tile type A-B1 injuries tended not to cause BC. Patients with a BC suffered more concomitant injuries of the thorax, abdomen and the extremities (91%), had a higher ISS, NISS and RISC2 (mean 38,2, 41,5 and 20,9), received more blood transfusions at admission (32,3%) and during the initial surgery (44,4%), had a longer duration of intensive care (mean 15,5 days) and allover length of hospital stay (mean 28,4 days) than patients without a BC (nBC). The outcome (well recovered or moderately disabled) was better in patients without a BC (nBC). The mortality was higher in patients with a BC (21,1%). 85% were prehospitally stabilized with a PCCD, 15% belated in the ER. 57,6% underwent an emergency intervention in the operating room (OR), mostly (48,9%) with an external fixator. Patients with a PCCD had fewer concomitant injuries (90,3%) in general, but a higher ISS, NISS and RISC2 (mean 39,6, 42,6 and 23,5), received more blood transfusions (p > = 0,05) in the ER (35,4%) and during the initial surgery (42,5%), were about 10 years younger (mean 40,1 years), required longer intensive care (mean 16,0 days), than patients without a PCCD. The vast majority of the patients with a PCCD had a worse outcome (severely disabled or dead) than patients without a PCCD. Regardless the classification (Tile type B and C), the mortality was not significantly higher in patients without a PCCD.
Conclusion:
BC were more often identified in patients with Tile type (B2), B3-C3 injuries. Tile type A-B1 injuries tended not to cause BC. Based on data from the German Pelvis Registry in combination with data from the TraumaRegister DGU® this study is not able to proof the undisputed clinical benefit of PCCD’s. Nevertheless, the recommendations from the national guideline on treatment of polytrauma/severe injuries should be continued, as to apply a PCCD as soon as possible in case of a suggested pelvic ring injury and especially in hemodynamically unstable trauma patients. The external fixator remains the preferred measure for the emergency stabilization of pelvic ring injuries in the OR.