Preperitoneal pelvic packing

Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift.

Cothren CC, Osborn PM, Moore EE, et al. The Journal of trauma 2007 · PMID 17426537 · doi:10.1097/ta.0b013e31803c7632

Question

Does a protocol of preperitoneal pelvic packing with external fixation control haemorrhage and reduce mortality in haemodynamically unstable pelvic fractures?

Design

Prospective single-centre cohort from Denver Health with comparison against historical controls.

Patients

Patients with pelvic fractures who remained haemodynamically unstable despite resuscitation.

Intervention

Preperitoneal pelvic packing plus pelvic external fixation, with angiography reserved for ongoing bleeding

Comparison

Historical angiography-first protocol

Primary outcome

Mortality from acute haemorrhage and transfusion requirement

Key result

Packing was associated with rapid haemorrhage control, reduced post-procedure transfusion and low mortality from acute haemorrhage, with only a minority needing subsequent angioembolisation.

Limitations

Single-centre, non-randomised design with historical controls; results depend on a system able to deliver packing immediately.

Impact on practice

Established preperitoneal packing as an alternative or adjunct to angioembolisation for the unstable patient, now part of UK major trauma centre haemorrhage pathways alongside binders and interventional radiology.