Clinical Pathway of Croce et al for Managing a Patient with an Unstable Pelvic Fracture

 

Patient selection: unstable pelvic fracture

 

Parameters:

(1) initial hemodynamic status

(2) hemodynamic status after application of an external pelvic orthotic device (POD)

(3) presence of a major extrapelvic source of hemorrhage

Initial Hemodynamics	Hemodynamics After POD	Extrapelvic Hemorrhage	Immediate Management
stable	NA	NA	proceed to resolution (below)
unstable	stable	NA	proceed to resolution (below)
unstable	unstable	yes	control extrapelvic hemorrhage, then go to resolution steps
unstable	unstable	no	pelvic angiography, then go to resolution steps

 

where:

• In looking at Figure 1, there may be a loop back missing for when the patient remains hemodynamically unstable after control of extrapelvic hemorrhage.

 

Resolution steps:

(1) Address other injuries.

(2) Perform elective pelvic fixation.

 

The main point of the article is to emphasize the benefits of the external POD for temporarily stabilizing the pelvis and controlling hemorrhage. It is similar to the pneumatic antishock garment. It is noninvasive, does not require anesthesia and can be placed during the initial resuscitation.