Discussion of damage control procedures for treating severe open pelvic fractures

ZHAO Shan-hong; GAO Jin-mou; HU Ping; XIANG Zhen

Abstract：Objective To discuss the damage control procedures during the surgical process of severe open pelvic fractures combined with the adjacent organ injuries .Methods Clinical data of 21 cases of severe open pel-vic fractures admitted from Jan .2002 to Dec.2011 were retrospectively analyzed .Early internal iliac artery ligation was performed in 19 cases,selective internal iliac artery embolization in 2 cases;abdominal packing in 11 cases;bladder stoma in 7 cases,bladder repair plus urethral realignment in 2 cases;primary repair of intraperitoneal color-ectal wound in 4 cases;stoma in 1 case;extraperitoneal rectal injury and colostomy in 13 cases,proximal and distal clamps were applied in the Ⅱperiod in 3 cases;external fixation of pelvis in 14 cases.Definitive reconstructive fix-ation and colorectal and posterior urethral reconstruction were performed at late stage .Results The overall mortali-ty rate was 29%(6/21):hemorrhagic shock in 5 cases,MODS in 1 case.Complications occurred in 7 cases:recto-vesical fistula in 3 cases,abdominal compartment syndrome (ACS) in 2 cases,iliac vascular thrombosis in 1 case and paraplegia in 1 case.Except for the patients with paraplegia ,the rest were cured via non-surgical treatment .Con-clusion Ligation of internal iliac arteries and abdominal packing are important means for bleeding due to severe open pelvic fractures;initial diversion should be performed in patients with cystostomy and colostomy .External fixa-tion of pelvis should be placed .