Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)

Magnone, Stefano; Coccolini, Federico; Manfredi, Roberto; Piazzalunga, Dario; Agazzi, Roberto; Arici, Claudio; Barozzi, Marco; Bellanova, Giovanni; Belluati, Alberto; Berlot, Giorgio; Biffl, Walter; Camagni, Stefania; Campanati, Luca; Castelli, Claudio Carlo; Catena, Fausto; Chiara, Osvaldo; Colaianni, Nicola; De Masi, Salvatore; Di Saverio, Salomone; Dodi, Giuseppe; Fabbri, Andrea; Faustinelli, Giovanni; Gambale, Giorgio; Capponi, Michela Giulii; Lotti, Marco; Marchesi, Gian Mariano; Massè, Alessandro; Mastropietro, Tiziana; Nardi, Giuseppe; Niola, Raffaella; Nita, Gabriela Elisa; Pisano, Michele; Poiasina, Elia; Poletti, Eugenio; Rampoldi, Antonio; Ribaldi, Sergio; Rispoli, Gennaro; Rizzi, Luigi; Sonzogni, Valter; Tugnoli, Gregorio; Ansaloni, Luca

doi:10.1186/1749-7922-9-18

World Journal of Emergency Surgery

Table 2 Revised papers 1990-2013

From: Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)

	Reference	Year	Design	Patients	Comments
1	Burgess [1]	1990	Prospective	25 unstable	Acute external fixation and angio
2.	Flint [10]	1990	Prospective observational	60	Use of PASG, 37/60 had ORIF within 24 hrs, only 4 ext fix
3.	Latenser [11]	1991	Prospective with historical controls	18/19	Early defined as internal or external fixation within 8 hrs from arrival
4.	Broos [12]	1992	Retrospective	44 type B and C fractures	Immediate fixation
5.	Gruen [13]	1994	Retrospective	36 unstable	Angio and anterior urgent ORIF [within 2-3 days]
6.	Van Veen [14]	1995	Retrospective	9 unstable	Peritoneal packing, bilateral ligation of internal iliac artery, EF and/or ORIF within 6 hours
7.	Heini [15]	1996	Retrospective	18 unstable	C clamp placement
8.	Bassam [16]	1998	Prospective observational	15 unstable	External fixation first if anterior fracture, angio first if posterior fracture
9.	Velmahos [17]	2000	Retrospective	30 unstable	Bilateral embolization of iliac internal artery
10.	Wong [18]	2000	Retrospective	17 unstable	External fixation and angio, either before or after
11.	Biffl [19]	2001	Observational with historical controls	50/38 systolic blood pressure < 90	Use of angio and early external fixation or C clamp
12.	Ertel [20]	2001	Retrospective	20	Use of C clamp and pelvic packing
13.	Cook [21]	2002	Retrospective	74 unstable [23 underwent angio]	Exernal fixation and angio
14.	Kushimoto [22]	2003	Retrospective	29 mixed population	Angio before and after Damage Control Laparotomy. No pelvic packing or external fixation. High mortality.
15.	Miller [23]	2003	Retrospective	35 unstable	Angio and then external fixation. If laparotomy first angio done after external fixation
16.	Hagiwara [24]	2003	Prospective	61 stable and unstable	Angio and then external fixation in the angio suite
17.	Ruchholtz [25]	2004	Prospective	21 unstable	Early external fixation in mechanically unstable fractures
18.	Fangio [26]	2005	Retrospective	32 unstable	Angio first usually. No packing. Laparotomy before or after angio. Some external fixation
19.	Sadri [27]	2005	Retrospective	14 unstable	C clamp and then angio
20.	Krieg [28]	2005	Prospective	16 unstable	Outcomes following pelvic belt
21.	Croce [29]	2007	Retrospective	186 [stable and unstable]	Use of External fixation or T-POD® and angio
22.	Lai [30]	2008	Retrospective	7 unstable	External fixation and angio
23.	Richard [31]	2009	Prospective	24 APC-2 pelvic injuries [11 unstable]	Anteriorly placed C-clamp [in the ER, angio suite or OR]
24.	Morozumi [32]	2010	Retrospective	12 unstable	Mobile angio first. No packing or fixation
25.	Jeske [33]	2010	Retrospective	45 unstable	External fixation and angio
26.	Enninghorst [34]	2010	Retrospective	18 unstable	Acute ORIF [< 24 hrs]
27.	Tan [35]	2010	Prospective	15 unstable	Application of T-POD®
28.	Cherry [36]	2011	Retrospective	12 unstable	OR angio.
29.	Karadimas [37]	2011	Retrospective	34 mixed population	External fixation and secondary angio.
30.	Hornez [38]	2011	Retrospective	17 unstable	Pelvic packing, angio and fixation.
31.	Fang [39]	2011	Retrospective	76 unstable	Mixed population [60% unstable fractures]. Angio and/or laparotomy. No packing.
32.	Tai [40]	2011	Retrospective	24 unstable	Shift to pelvic packing and external fixation before angio
33.	Burlew [41]	2011	Prospective	75	Preperitoneal pelvic packing and external fixation in emergency. Secondary angiography
34.	Fu [42]	2012	Retrospective	28 unstable	Angio [available 24 hrs] directly if negative FAST. Intraperitoneal packing. No fixation.
35.	Hu [43]	2012	Retrospective	15 unstable	External fixation
36.	Metsemakers [44]	2013	Retrospective	98 unstable	External fixation first, no pelvic packing for closed fractures. Then angio [13 embolized out of 15 angio done]
37.	Abrassart [45]	2013	Retrospective	70 unstable	4 groups with either external fixation only, together with angio, laparotomy or angio before external fixation

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ISSN: 1749-7922

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