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  1. Home /
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  3. Vol 51 No 4 (2020): Damage Control Surgery (I) /
  4. Reviews

Hemodynamically Unstable Pelvic Fracture: A Damage Control Surgical Algorithm that Fits your Reality

  • Abstract
  • Keywords
  • Author Biographies
  • References

Abstract

Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.

Authors

  • David Alejandro Mejia • Department of Surgery, Hospital Pablo Tobon Uribe, Medellin, Colombia. • Department of Surgery, Universidad de Antioquia, Medellin, Colombia. https://orcid.org/0000-0003-0617-4303
  • Michael Parra Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA https://orcid.org/0000-0001-6496-6275
  • Carlos Alberto Ordoñez • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. https://orcid.org/0000-0003-4495-7405
  • Natalia Padilla Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0003-3292-6919
  • Yaset Caicedo • Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0002-6128-0128
  • Salin Pereira-Warr Grupo de Soporte Nutricional. Hospital Pablo Tobón Uribe. Medellin. Colombia https://orcid.org/0000-0002-8259-8274
  • Paula Andrea Jurado Department of General Surgery. Hospital Pablo Tobón Uribe – Universidad de Antioquia, Medellín, Colombia https://orcid.org/0000-0002-6688-9944
  • Mauricio Torres Department of Orthopedic Surgery. Fundación Valle del Lili. Cali, Colombia
  • Alfredo Martinez Department of Orthopedic Surgery. Fundación Valle del Lili. Cali, Colombia https://orcid.org/0000-0003-4902-5703
  • Jose Julian Serna • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0001-9829-8930
  • Fernando Rodriguez Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. https://orcid.org/0000-0002-5326-2317
  • Alexander Salcedo • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0001-8187-0638
  • Alberto Garcia • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. https://orcid.org/0000-0002-4096-1434
  • Mauricio Millan • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0002-5502-5745
  • Luis Fernando Pino • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-1179-2854
  • Adolfo Gonzalez Hadad • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia https://orcid.org/0000-0001-5862-4906
  • Mario Alain Herrera • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-4526-7636
  • Ernest Moore Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA. https://orcid.org/0000-0002-0419-4848

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Keywords

  • Hemodynamically Unstable
  • Damage Control
  • Pelvic Fracture
  • REBOA
  • Limited Resource Center

Author Biographies


, • Department of Surgery, Hospital Pablo Tobon Uribe, Medellin, Colombia. • Department of Surgery, Universidad de Antioquia, Medellin, Colombia.

orcid_id14.png https://orcid.org/0000-0003-0617-4303


, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA

orcid_id14.png https://orcid.org/0000-0001-6496-6275


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405


, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0003-3292-6919


, • Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6128-0128


, Grupo de Soporte Nutricional. Hospital Pablo Tobón Uribe. Medellin. Colombia

orcid_id14.png https://orcid.org/0000-0002-8259-8274


, Department of General Surgery. Hospital Pablo Tobón Uribe – Universidad de Antioquia, Medellín, Colombia

orcid_id14.png https://orcid.org/0000-0002-6688-9944


, Department of Orthopedic Surgery. Fundación Valle del Lili. Cali, Colombia

orcid_id14.png https://orcid.org/0000-0003-4902-5703


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-9829-8930


, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-5326-2317


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8187-0638


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4096-1434


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5502-5745


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1179-2854


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-5862-4906


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4526-7636


, Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA.

orcid_id14.png https://orcid.org/0000-0002-0419-4848

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2020-12-30
Submitted
2020-08-20
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How to Cite
Mejia, D., Parra, M., Ordoñez, C. A., Padilla, N., Caicedo, Y., Pereira-Warr, S., Jurado, P., Torres, M., Martinez, A., Serna, J., Rodriguez, F., Salcedo, A., Garcia, A., Millan, M., Pino, L., Gonzalez Hadad, A., Herrera, M., & Moore, E. (2020). Hemodynamically Unstable Pelvic Fracture: A Damage Control Surgical Algorithm that Fits your Reality. Colombia Médica, 51(4), e4214510. https://doi.org/10.25100/cm.v51i4.4510
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