Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE


  • Mohammed Alkatary Department of Surgery, Mansoura University Hospital, Egypt
  • Jody Robert Miller Department of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, UAE
  • Fawzi Al Ayoubi Department of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, UAE



Angio-embolization, Hemodynamic instability, Pelvic fracture, Preperitoneal packing


Background: Multidisciplinary team and multiple approaches were introduced to improve the outcome after significant pelvic trauma. In present study, we are evaluating our institutional management modalities for unstable patients with unstable pelvic fractures using angio-embolization, pelvic packing with or without angio-embolization and conservative management with surgical intensive care unit (SICU) admission.

Methods: We reviewed 108 patients admitted with pelvic fractures from January 2013 to September 2014, 19 patients (17.5%) were hemodynamically unstable with pelvic fracture. Massive transfusion protocol was activated in all patients. FAST scan was done. Level 1 trauma CT for the responder and transient responder patients.

Results: Out of 19 patients, 7 patients (36.8%) were good responders to resuscitation with maintaining of their hemoglobin stable, with no extravasation of dye, admitted to SICU for conservative management. 4 patients (21%) were responders with CT trauma revealed dye leak so they underwent angio-embolization, SICU admission. 8 patients (42.1%) were non-responders underwent preperitoneal packing, one of them had additional angio-embolization.

Conclusions: Preperitoneal packing is an excellent choice for non-responder patients, while angio-embolization can be done for responder and transient responder patients with evident dye extravasation. This study needs more evaluation on a wider clinical scale.

Author Biographies

Jody Robert Miller, Department of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, UAE

Trauma and Acute Care Surgery department

Fawzi Al Ayoubi, Department of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, UAE

Trauma and Acute Care Surgery department


Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 2005;36:1-13.

DiGiacomo JG, Bonadies JA, Cole FJ. Practice management guidelines for hemorrhage in pelvic fracture (EAST Website), 2001. Available at Accessed October 1, 2009.

DeAngelis NA, Wixted JJ, Drew J, Eskander MS, Eskander JP, French BG. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior-posterior compression type pelvic fractures: a cadaveric study. Injury. 2008;39:903-6.

Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A, et al. East practice management guidelines work group: practice management guidelines for the evaluation of blunt abdominal trauma. J Trauma. 2002;53(3):602-15.

Bassam D, Cephas GA, Ferguson KA, Beard LN, Young JS. A protocol for the initial management of unstable pelvic fractures. Am Surg. 1998;64:862-7.

Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T, et al. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg. 2001;233(6):843-50.

Hedrick-Thompson JK. A review of pressure reduction device studies. J Vasc Nurs. 1992;10:3-5.

Spanjersberg WR, Knops SP, Schep NW, Van Lieshout EM, Patka P, Schipper IB. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009;40:1031-5.

Metsemakers WJ, Vanderschot P, Jennes E, Nijs S, Heye S, Maleux G. Transcatheter embolotherapy after external surgical stabilization is a valuable treatment algorithm for patients with persistent haemorrhage from unstable pelvic fractures: outcomes of a single centre experience. Injury. 2013;44:964-8.

Metz CM, Hak DJ, Goulet JA, Williams D. Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage. Orthop Clin North Am. 2004;35:431-7.

Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma. 1985;25:1021-9.

Rossaint R, Duranteau J, Stahel PF, Spahn DR. Nonsurgical treatment of major bleeding. Anesthesiol Clin. 2007;25:35-48.

Velmahos GC, Toutouzas KG, Vassiliu P, Sarkisyan G, Chan LS, Hanks SH, et al. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma. 2002;53:303-8.

Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009;40:343-53.

Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraxes: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57:288-95.

Burlew CC, Moore EE, Smith WR, Johnson JL, Biffl WL, Barnett CC, et al. Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J Am Coll Surg. 2011;212:628-35.

Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AE, et al. Direct retroperitoneal pelvic packing versus pelvic angiography: A comparison of two management protocols for hemodynamically unstable pelvic fractures. Injury. 2009;40:54-60.

Li Q, Dong J, Yang Y, Wang G, Wang Y, Liu P, et al. Retroperitoneal packing or angioembolization for hemorrhage control of pelvic fractures--Quasi-randomized clinical trial of 56 hemodynamically unstable patients with Injury Severity Score ≥33. Injury. 2016;47(2):395-401.

White CE, Hsu JR, Holcomb JB. Hemodynamically unstable pelvic fracture. Injury. 2009;40:1023-30.

Papakostidis C, Giannoudis PV. Pelvic ring injury with hemodynamic instability: efficacy of pelvic packing, a systemic review. Injury 2009;40(4): S53-61.

Gruven GS, Leit ME, Gruen RJ, Peitzman AB. The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fracture. J Trauma 2994;36(5):706-11.

Krieg JC, Mohr M, Cllis TJ, Simpson TS, Madey SM, Bottlarg M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005;59:659-64.

Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am. 2002;84(2):43-7.

Piper GL, Peitzman AB. Current management of hepatic trauma. Surg Clin North Am. 2010;90:775-85.

Walt AJ, Wilson RF. Management of trauma: pitfalls and practice. Philadelphia: Lea Febiger; 1975:348.

Smith WR, Moore EE, Osborn P, Agudelo JF, Morgan SJ, Parekh AA, et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and a description of technique. J Trauma. 2005;59:1510-4.






Original Research Articles