Pre-peritoneal Pelvic Pack with External Fixator versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; a Historical Cohort Study

BackgroundPelvic fracture is one of the most common cause of death in traumatic patients. This study was designed to compare the outcome, morbidity and complications of treatment with pre-peritoneal pelvic pack with external fixator against pelvic pack alone in traumatic pelvic fracture and unstable hemodynamic patients.MethodsIn a retrospective case control study, patients with pelvic fracture and unstable hemodynamic state who referred to emergency and surgery department from August 2018 to August 2019 were enrolled by census manner. In the control group, 25 patients treated just by a pre-peritoneal pack (PPP group), while in the case group, pre-peritoneal pack and external fixator was done as the procedure to control bleeding (PPP Plus fixator group) in 22 individuals. Two groups were compared for presence of thromboembolism, hospital stay, infection, BUN, creatinine, rate of blood transfusion and mortality. ResultsMean age of participants were 34.48 ± 13.79 in pelvic pack group, while it was 32.36±16.29 in PPP plus external fixator ones. The mean Injury Severity Score (ISS) was 23.12±9.85 in Pelvic Pack group, and 19.22±8.09 in PPP plus external fixator group. Acute kidney injury was reported in 6 (24%) individuals of PPP group, while its rate in PPP plus fixator group was 40.9%. Mortality rate was reported 32% and 4.5% in control and case groups, respectively. There was a significant difference between groups (p=0.017, LR=6.42). VTE was reported 12% and 4.5% in PPP group and PPP plus fixator ones, respectively.ConclusionIt was concluded that using external fixator with PPP can be a useful method for treatment of pelvic fracture that is unstable in hemodynamic situation. It is recommended to use biomarkers like lactate or others to determine the situation of patients as precise as possible.