Retroperitoneal pelvic packing for haemodynamically unstable pelvic fractures in children and adolescents: A level-one trauma-centre experience

• Published in: Journal of pediatric surgery 2012-12, Vol.47 (12), p.2244-2250
• Main Authors: Chao, Nicholas S.Y, Liu, Clarence S.W, Chung, Kenneth L.Y, Tang, Paula M.Y, Tai, Dora K.C, Lee, K.Y, Chang, Annice, Leung, Michael W.Y, Liu, Kelvin K.W
• Format: Article
• Language: English
• Subjects: Adolescent; Angiography - methods; Child; Children; Cohort Studies; External Fixators; Female; Follow-Up Studies; Fracture; Fracture Fixation - instrumentation; Fracture Fixation - methods; Fractures, Bone - complications; Fractures, Bone - diagnostic imaging; Fractures, Bone - surgery; Hemoperitoneum - etiology; Hemoperitoneum - mortality; Hemoperitoneum - surgery; Hemostatic Techniques; Hospital Mortality; Humans; Injury Severity Score; Male; Pediatrics; Pelvic; Pelvic Bones - injuries; Retroperitoneal packing; Retroperitoneal Space; Retrospective Studies; Risk Assessment; Shock, Hemorrhagic - etiology; Shock, Hemorrhagic - mortality; Shock, Hemorrhagic - physiopathology; Shock, Hemorrhagic - surgery; Surgery; Survival Rate; Tampons, Surgical; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.09.015

Abstract Purpose This study aims to review the outcomes of haemodynamically unstable paediatric patients with pelvic fractures undergoing protocol intervention of retroperitoneal pelvic packing (RPP) with external fixation and angiography. Methods From 2004 to 2011, consecutive patients younger than 19 years treated in our centre for haemodynamically unstable pelvic fractures were retrospectively reviewed. From 2008, protocol intervention triad of external fixation, RPP, and angiography with embolization was implemented. Results Before 2008, only 2 boys with fall injuries received intervention. One received initial angiography showing extravasation near iliac bifurcation. Laparotomy proceeded without embolization for multiple visceral injuries, but he succumbed postoperatively. The other had persistent bleeding after external fixation but became stabilized after embolization. After 2008 protocol implementation, 5 youngsters received the triad of interventions for unstable pelvic fractures. Mean age was 15.4 yrs. The mean injury severity score was 42 (18–66) with 62.5% mean probability of survival (6.8–98.8%). The mean operating time for RPP was 23 mins (20–35 mins). One boy died of rapid exanguination intraoperatively. The other 4 youngsters recovered for rehabilitation. Conclusion Fall from heights is a major cause for severe pelvic injuries in our locality. RPP is a simple effective procedure to include in protocol intervention for pelvic fractures. This case series suggests it helps improve haemostasis and survival in unstable young patients, although larger cohorts will be necessary to validate this.