HEMORRHAGIC SHOCK AND ASSOCIATED INJURIES WITH MORTALITY RISK IN POLYTRAUMA PATIENTS WITH PELVIC FRACTURES
Abstract:
The severe pelvic ring fractures with major hemorrhage are rare but these injuries increase
the mortality rate in polytrauma patients. The aim of this retrospective study was to evaluate the results
of the severe polytrauma cases including the severe pelvic fractures and major hemorrhage. Materials
and methods: The present study evaluated 12.000 polytrauma patients admitted in Emergency Surgical
Department in two Emergency Hospitals between 1978-2014, 200 cases with pelvic ring disruption and
severe hemorrhage. The present study is addressed to the 200 cases with complicated pelvic ring
fractures. All patients with unstable pelvic ring fractures were temporarily stabilized and those with
ongoing hemorrhage underwent emergency laparotomy with or without extra peritoneal pelvic packing.
In the present study the patients were including in early survivors (surviving the first 12 hours after
admission) and deceased. We performed the statistics by Mann-Whitney test, with significance at
p<0,05. Results: In the present study 64 (32%) patients with severe fractures and hemorrhagic shock
passed away due to hemorrhagic shock. Commonly associated vascular injuries were the injuries of the
venous plexus of the bladder, diffuse hemorrhage from the pelvic ring, hemorrhage from the
retroperitoneal space. Other complications associated were the injuries of the urethra, bladder. The
majority of the bladder injuries are extra peritoneal and result from shearing forces or direct laceration
by bone splinters. In the present studies, the urethral disruption is complicated with stricture or
incontinence. Overall mortality was 40%. Conclusions: Traumatic disruption of the pelvic ring is a
major cause of life threatening hemorrhage, mainly due to extensive venous bleeding from the presacral
venous plexus. The key elements in managing patients with pelvic fractures are swift and adequate
resuscitation, reverse of shock and acidosis and rapid control of hemorrhage in order to facilitate
survival of these patients.
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