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Schockraummanagement bei Verletzungen des Beckens

Eine systematische Literaturübersicht

Emergency room management of pelvic injuries: a systematic review of the literature

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Zusammenfassung

Fragestellung.

Beckenverletzungen können eine vitale Bedrohung darstellen, was sofortiges operatives Handeln erfordert. Eine Literaturübersicht soll hierzu aktuelle Empfehlungen gegenüberstellen.

Methodik.

Klinische Studien wurden über systematische Literatursuchen (Medline, Cochrane und Handsuchen) gesichtet und nach Klassifikation und Evidenzgüte (nach Oxforder Schema) zusammengetragen.

Ergebnisse.

Aus der Literaturübersicht lassen sich weitestgehend übereinstimmende Empfehlungen bezüglich der Dringlichkeit der operativen Versorgung und der Kreislaufstabilisierung bei komplexen Beckenverletzungen ableiten. In Diskussion ist die Art der Notfallstabilisierung (Fixateur externe oder Beckenzwinge), Art und Umfang der Röntgendiagnostik (Nativ und/oder nur CT) und die Art der Blutstillung (Tamponade oder Embolisation).

Schlussfolgerungen.

Das Schockraummanagement bei Beckenverletzungen beinhaltet in erster Linie die Therapie einer vitalen Bedrohung, die von einer komplexen Beckenverletzung ausgehen kann. Hierzu stehen verschiedene Methoden zur Auswahl, einheitlich ist das Prinzip der parallelen Kreislaufstabilisierung und mechanischen Stabilisierung des Beckenrings.

Abstract

Objective.

Injuries to the pelvis may occur as a life threatening situation which then requires immediate surgical treatment. A review of the literature represents the range of current recommendations.

Methods.

Clinical trials were systematically collected (Medline, Cochrane and hand searches) reviewed and classified into evidence levels (1 to 5 according to the Oxford system).

Results.

According to the literature there is a consent that immediate resuscitation and surgical intervention is essential in complex pelvic fractures. In contrast the way of emergency stabilization of the pelvis (fixateur externe or c-clamp) is still under discussion as well as the radiological diagnostic (x-ray or CT) and the way of bleeding control (tamponade or embolization).

Conclusion.

Emergency management of pelvic fractures means treatment of a life threatening injury in first place. Although there are different methods that can be used, they all follow the same principle of resuscitation and mechanical stabilization of the pelvis in parallel.

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Literatur

  1. Adams JE, Davis GG, Alexander CB, Alonso JE (2003) Pelvic trauma in rapidly fatal motor vehicle accidents. J Orthop Trauma 17: 406–410

    Google Scholar 

  2. Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed JF (1997) Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 43: 395–399

    CAS  PubMed  Google Scholar 

  3. Ben-Menachem Y, Coldwell D, Young J, Burgess A (1991) Hemorrhage associated with pelvic fractures: causes, diagnosis and emergent management. AJR Am J Roentgenol 157: 1005–1014

    CAS  PubMed  Google Scholar 

  4. Berg EE, Chebuhar C, Bell RM (1996) Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms. J Trauma 41: 994–998

    CAS  PubMed  Google Scholar 

  5. Blackmore CC, Jurkovich GJ, Linnau KF, Cummings P, Hoffer EK, Rivara FP (2003) Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg 138: 504–508

    Article  PubMed  Google Scholar 

  6. Bone L (1992) Emergency treatment of the injured patient. In: Browner B, Jupiter J, Levine A, Trafton P (eds) Skeletal trauma. Saunders, Philadelphia London Toronto

  7. Bosch U, Pohlemann T, Tscherne H (1992) Primary management of pelvic fractures. Orthopäde 21: 385–392

    Google Scholar 

  8. Cook RE, Keating JF, Gillespie I (2002) The role of angiography in the management of hemorrhage from major fractures of the pelvis. J Bone Joint Surg Br 84: 178–182

    Article  CAS  PubMed  Google Scholar 

  9. Culemann U, Tosounidis G, Reilmann H, Pohlemann T (2003) Pelvic fracture. Diagnostics and current treatment options. Chirurg 74: 687–698

    Article  CAS  PubMed  Google Scholar 

  10. Dalal SA, Burgess AR, Siegel JH et al. (1989) Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 29: 981–1001

    CAS  PubMed  Google Scholar 

  11. Edeiken-Monroe B, Browner BD, Jackson H (1989) The role of standard roentgenograms in the evaluation of instability of pelvic ring disruption. Clin Orthop 240: 63–78

    PubMed  Google Scholar 

  12. Ertel W, Keel M, Eid K, Platz A, Trentz O (2001) Control of severe hemorrhage using C-clamp and pelvic packing in mutiply injured patients with pelvic ring disruption. J Orthop Trauma 15: 468–474

    Article  CAS  PubMed  Google Scholar 

  13. Euler E, Nast-Kolb D, Schweiberer L (1997) Hüftpfannen- und Beckenfrakturen beim Polytrauma. Orthopäde 26: 354–359

  14. Failinger M, McGanity P (1992) Unstable fractures of the pelvic ring. J Bone Joint Surg Am 74: 781–791

    CAS  PubMed  Google Scholar 

  15. Falchi M, Rollandi GA (2004) CT of pelvic fractures. Eur J Radiol 50: 96–105

    Article  PubMed  Google Scholar 

  16. Guillamondegui OD, Mahboubi S, Stafford PW, Nance ML (2003) The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures. J Trauma 55: 236–239

    PubMed  Google Scholar 

  17. Hagiwara A, Minakawa K, Fukushima H, Murata A, Masuda H, Shimazaki S (2003) Predictors of death in patients with life-threatening pelvic hemorrhage after successful transcatheter arterial embolization. J Trauma 55: 696–703

    PubMed  Google Scholar 

  18. Harley JD, Mack LA, Winquist RA (1982) CT of Acetabular fractures: Comparison with conventional radiography. AJR Am J Roentgenol 138: 413–417

    CAS  PubMed  Google Scholar 

  19. Hölting T, Buhr H, Richter G, Roeren T, Friedl W, Herfarth C (1992) Diagnosis and treatment of retroperitoneal hematoma in multiple trauma patients. Arch Orthop Trauma Surg 111: 323–326

    PubMed  Google Scholar 

  20. Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC (2003) External fixation or arteriogram in bleeding pelvic fracture: Initial therapy guided by markers of arterial hemorrhage. J Trauma 54: 437–443

    PubMed  Google Scholar 

  21. Mucha PJ, Welch TJ (1988) Hemorrhage in major pelvic fractures. Surg Clin North Am 68: 757–773

    PubMed  Google Scholar 

  22. Panetta T, Sclafani S, Goldstein A, Phillips T, Shaftan G (1985) Percutaneous transcatheter embolisation for massive bleeding from pelvic fractures. J Trauma 25: 1021–1029

    CAS  PubMed  Google Scholar 

  23. Pehle B, Nast-Kolb D, Oberbeck R, Waydhas C, Ruchholtz S (2003) Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room. Unfallchirurg 106: 642–648

    Article  CAS  PubMed  Google Scholar 

  24. Pereira SJ, O’Brien DP, Luchette FA et al. (2000) Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery 128: 678–685

    Article  CAS  PubMed  Google Scholar 

  25. Petrisor BA, Bhandari M, Orr RD, Mandel S, Kwok DC, Schemitsch EH (2003) Improving reliability in the classification of fractures of the acetabulum. Arch Orthop Trauma Surg 123: 28–233

    PubMed  Google Scholar 

  26. Pohlemann T, Krettek C, Hoffmann R, Culemann U, Gänsslen A (1994) Biomechanical comparison of various emergency stabilization measures of the pelvis ring. Unfallchirurg 97: 503–510

    CAS  PubMed  Google Scholar 

  27. Pohlemann T, Paul C, Gänsslen A, Regel G, Tscherne H (1996) Die traumatische Hemipelvektomie: Erfahrungen aus 11 Fällen. Unfallchirurg 99: 304–312

    Article  CAS  PubMed  Google Scholar 

  28. Pohlemann T, Culemann U, Gänsslen A, Tscherne H (1996) Die schwere Beckenverletzung mit pelviner Massenblutung: Ermittlung der Blutungsschwere und klinische Erfahrung mit der Notfallstabilisierung. Unfallchirurg 99: 734–743

    Article  CAS  PubMed  Google Scholar 

  29. Resnik CS, Stackhouse DJ, Shanmuganathan K, Young JWR (1992) Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radographs. AJR Am J Roentgenol 158: 109–112

    CAS  PubMed  Google Scholar 

  30. Sheridan MK, Blackmore CC, Linnau KF, Hoffer EK, Lomoschitz F, Jurkovich GJ (2002) Can CT predict the source of arterial hemorrhage in patients with pelvic fractures? Emerg Radiol 9: 188–194

    Google Scholar 

  31. Siegmeth A, Mullner T, Kukla C, Vecsei V (2000) Associated injuries in severe pelvic trauma. Unfallchirurg 103: 572–581

    Article  CAS  PubMed  Google Scholar 

  32. Silber JS, Flynn JM, Koffler KM (2001) Analysis of the cause, classification and associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop 21: 446–450

    Article  CAS  PubMed  Google Scholar 

  33. Stewart BG, Rhea JT, Sheridan RL, Novelline RA (2002) Is the screening portable pelvis film clinically useful in multiple trauma patients who will be examined by abdominopelvic CT? Experience with 397 patients. Emerg Radiol 9: 266–271

    Google Scholar 

  34. Tarman GJ, Kaplan GW, Lerman SL, McAleer IM, Losassso BE (2002) Lower genitourinary injury and pelvic fractures in pediatric patients. Urology 59: 123–126

    Article  PubMed  Google Scholar 

  35. Torode I, Zeig D (1985) Pelvic fractures in children. J Pediatr Orthop 5: 76–84

    CAS  PubMed  Google Scholar 

  36. Trafton PG (1990) Pelvic ring injuries. Surg Clin North Am 70: 655–669

    CAS  PubMed  Google Scholar 

  37. Trunkey D (1983) Trauma. Sci Am 249: 28

    CAS  PubMed  Google Scholar 

  38. Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160: 445–451

    Google Scholar 

  39. Sackett DL, Richardson WS, Rosenberg W, Haynes RB (1997) Evidence-based medicine: How to practice and teach EBM. Churchill Livingstone, London

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar

    A. Seekamp, M. Burkhardt & T. Pohlemann

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar

    A. Seekamp

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  1. A. Seekamp
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Correspondence to A. Seekamp.

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Seekamp, A., Burkhardt, M. & Pohlemann, T. Schockraummanagement bei Verletzungen des Beckens. Unfallchirurg 107, 903–910 (2004). https://doi.org/10.1007/s00113-004-0831-x

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