Strategies for the management of hemodynamically unstable pelvic fractures: From preperitoneal pelvic packing to definitive internal fixation

Background/Objective: Preperitoneal pelvic packing is useful, and favorable treatment outcomes have been reported. However, the timing of subsequent internal fixation of the pelvis is still debatable. We report the outcomes of a study on patients that underwent internal fixation after preperitoneal packing. Methods: A retrospective review was performed for patients with hemodynamically unstable pelvic fracture who underwent preperitoneal pelvic packing and internal fixation. Patients who underwent internal fixation with simultaneous packing removal were placed in Group 1. Patients who underwent definitive internal fixation later were placed in Group 2. Results: Of the 56 patients (mean age 44.7 years), 36 were male. The mean time from injury to internal fixation was 1.3 (1-2) days and 5.6 (3-10) days in Group 1 and 2, respectively. There was a significant difference in the mean duration of stay in the intensive care unit: 10.9 (3-54) days in Group 1 vs. 14.4 (5-43) days in Group 2 (p = 0.019). Thirty-one cases of complications occurred among 14 patients (25%), including six cases of surgical site infection. Among the six cases of infection, four were superficial and two were deep; five of these cases occurred in Group 2, including both cases of deep infection (p = 0.013). Conclusion: Performing internal fixation with packing removal should aid the return of the patient to a stable state, as it is possible to utilize the same incision line used for the original packing procedure, while providing stability to the pelvis. (C) 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.