Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
Department of Orthopaedic and Traumatology, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Eur J Orthop Surg Traumatol. 2023 Apr;33(3):515-523. doi: 10.1007/s00590-022-03420-x. Epub 2022 Nov 4.
Although improvement of pelvic trauma care has been successful in decreasing mortality rates in major trauma centers, such changes have not been implemented in low-resource environments such as low-middle-income countries (LMICs). This review details the evaluation and management of pelvic ring fractures and recommends improvements for trauma care in low-resource environments. Prehospital management revolves around basic life support techniques. Application of non-invasive pelvic circumferential compression devices, such as bed sheet or pelvic binders, can be performed as early as the scene of the accident. Upon arrival at the emergency department, rapid clinical evaluation and immediate resuscitation should be performed. Preperitoneal pelvic packing and external fixation devices have been considered as important first-line management tools to achieve bleeding control in hemodynamically unstable patients. After patient stabilization, immediate referral is mandated if the hospital does not have an orthopedic surgeon or facilities to perform complex pelvic/acetabular surgery. Telemedicine platforms have emerged as one of the key solutions for informing decision-making. However, unavailable referral systems and inaccessible transportation systems act as significant barriers in LMICs. Tendencies toward more "old-fashioned" protocols and conservative treatments are often justified especially for minimally displaced fractures. But when surgery is needed, it is important to visualize the fracture site to obtain and maintain a good reduction in the absence of intraoperative imaging. Minimizing soft tissue damage, reducing intraoperative blood loss, and minimizing duration of surgical interventions are vital when performing pelvic surgery in a limited intensive care setting.
尽管在重大创伤中心成功地改善了骨盆创伤护理，降低了死亡率，但这种变化尚未在资源匮乏的环境中实施，如中低收入国家（LMICs）。本综述详细介绍了骨盆环骨折的评估和管理，并为资源匮乏环境中的创伤护理提出了改进建议。 院前管理围绕着基本的生命支持技术。 可以在事故现场尽早使用非侵入性骨盆环周压缩装置，如床单或骨盆固定器。 到达急诊室后，应立即进行快速临床评估和立即复苏。 在血流动力学不稳定的患者中，应用前腹膜骨盆填塞和外固定装置已被认为是重要的一线治疗方法，以达到止血效果。 在患者稳定后，如果医院没有骨科医生或进行复杂骨盆/髋臼手术的设施，则需要立即转介。 远程医疗平台已成为决策信息的关键解决方案之一。 但是，转诊系统不可用和交通系统不可用是 LMICs 的重大障碍。 特别是对于轻度移位的骨折，往往倾向于采用更“老式”的方案和保守治疗。 但是，当需要手术时，在没有术中成像的情况下，重要的是要观察骨折部位以获得并保持良好的复位。 在有限的重症监护环境中进行骨盆手术时，最大限度地减少软组织损伤、减少术中失血量和缩短手术干预时间至关重要。
