Review of the Problems of Diagnosis of Endopelvic Haemorrhage, Its Intensity, Volume, and Duration, and Treatment Methods of Circulatory Injuries and Surgical Hemostasis after Pelvic Fractures
Table 1
Treatment options for patients with pelvic and hemodynamic instabilities.
Treatment
Advantages
Disadvantages
Effectiveness
Factitious tamponade
no
Effective only in hemodynamically stable patients
yes
In case of compartment damage
no
MAST
Direct compression (sizing-down the cavity) of pelvic ring and lower limbs
Access limitations to the damaged area Possible complications
no
Internal iliac artery bandaging
No
Full blown collateral
no
Pelvic girdle
Direct compression (sizing-down the cavity) of pelvis without limiting access to the damaged area Biomechanical effectiveness
unknown
possible
Angiography ∖ embolization
No necessity of open access to the retroperitoneum. Isolated haemorrhage can be stopped without surgery.
Arterial source of haemorrhage is discovered only in 10-20% of cases. Time-consuming. Dangerous with development of deep tissue necrosis.
possible
Temporary aorta pressing
Effective in acute situation
Limitations on time
yes
External fixation
Easy and fast administration of stopping haemorrhage by alignment of bone wounds, decreasing pelvic volume Prevention of repeated haemorrhage
Access limitations to the abdominal area. Low-efficiency in C – type damages
yes
Direct stopping of arterial hemorrhage
Stopping hemorrhages from great vessels
Manpower effort
yes
C – frame
Stabilization of back parts – base for tamponade
Special endeixis Possible complications
yes
Internal fixation after exploratory laparatomy.
High biomechanical effectiveness
Special endeixis Manpower effort Experience necessary
yes
Note MAST: medical antishock trousers (pneumocompression).
