1. Pelvic bind/Towel wrap Proprietary binders can be more convenient to apply but no evidence that one provides more support. MAST suits will interfere with subsequent laparotomy.
2. FAST scan Has advantage of repeatability. Can be replaced by DPL in an unstable patient but higher false positive rate results in negative laparotomy. Use supraumbilical open approach for DPL . Use CT abdomen for stable abdominal injuries. Note that DPL interferes with future FAST
3. Laparotomy can result in loss of control of pelvic haematoma. Pelvic must be stabilized (pelvic binder or operatively) prior to abdominal packing.
4. Ex. fixable injuries treatment is tailored to type of injury e.g. anterior fixator (for anterior injuries), Ganz/C-clamp (for posterior injuries). Incorrect use and application of clamps may worsen injury. (see classification of pelvic injuries).
5. Ex. fixation immediate anatomical reduction does not reduce transfusion requirements (once sheet wrap is applied). Ex. fix can be delayed in most cases.
6. Haemodynamic instability instability after modest fluid resuscitation 3L crystalloid/colloid
7. Angiography ideally located close to ED, ongoing resuscitation with trained personnel must continue during procedure. Only useful in arterial injuries (15-30%). More likely in open-book or complex injuries. Most other causes for bleeding respond to sheet wrap and modest resuscitation.
8. Repeat FAST sources for intra-abdominal bleeding need to be continually monitored in unstable patients for urgent transfer to theatre and laparotomy OR angio intervention
9. Further imaging best modality is CT pelvis but may include other plain views (see pelvic imaging). Concurrent CT abdomen usually required in major injuries.
Moss MC; Bircher M. Volume changes within the true pelvis during disruption of the pelvic ring - where does the haemorrhage go? Injury 1996;27 Suppl 1:S-A21
Kyle F. Dickson; Joel M. Matta, MD. Skeletal Deformity Following External Fixation of the Pelvis. American Academy of Orthopaedic Surgeons 1998 Annual Meeting - Scientific Program Paper No: 075
Ghanayem AJ, Wilber JH, Lieberman JM, Motta AO. The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury. J Trauma 1995 Mar; 38(3):396-400
Ghanayem AJ; Stover MD; Goldstein JA; Bellon E; Wilber JH. Emergent treatment of pelvic fractures. Comparison of methods for stabilization. Clin Orthop 1995 318:75-80
Waikakul S; Harnroongroj T; Vanadurongwan V. Immediate stabilization of unstable pelvic fractures versus delayed stabilization. J Med Assoc Thai 1999 Jul; 82(7):637-42
Gylling SF, WR, Holcroft JW, Bray TJ, Chapman MW. Immediate External Fixation of Unstable Pelvic Fractures. Am J Surg 1985 150(12): 721-724