Abstract
Background
In the emergency management of patients with pelvic fractures, there is ongoing debate
about the roles of angiography and open pelvic packing. It is agreed that some form
of haemorrhage control is required for patients who are haemo-dynamically unstable
despite resuscitation. We set out to determine whether on-call general and orthopaedic
surgeons would feel able to perform emergency surgical procedures for these patients
and whether vascular radiology was available to them.
Methods
Surveys were sent to all 221 general and orthopaedic surgeons in Wales. Questions
included: sub-speciality interest, geographical region, whether there is a pelvic
binder in their hospital, availability of interventional radiology, and whether surgeons
would perform a range of procedures to control haemorrhage in the emergency setting.
Results
There were 141 responses to the survey, giving a 64% response rate. Only 18% reported
that their unit had a formal rota for interventional radiology out of hours. 16% did
not know. 96% of orthopaedic surgeons would perform external fixation, although only
49% would use a C-clamp. 90% of general surgeons would be able to pack the pelvis
from within the abdominal compartment and 84% would be prepared to cross-clamp the
aorta if the situation required. Despite being widely recommended in the literature
as a method of haemorrhage control, our survey revealed only 45% would perform extra(pre)-peritoneal
packing of the pelvis (58% of general surgeons; 34% of orthopaedic surgeons) and only
12% had received formal training in this procedure.
Conclusions
With appropriately targeted training it is likely that the care of patients with pelvic
fractures can be significantly improved.
Keywords
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Article info
Publication history
Accepted:
November 26,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
