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Review
. 2017 Jan 18:12:5.
doi: 10.1186/s13017-017-0117-6. eCollection 2017.

Pelvic trauma: WSES classification and guidelines

Federico Coccolini  1 , Philip F Stahel  2 , Giulia Montori  1 , Walter Biffl  3 , Tal M Horer  4 , Fausto Catena  5 , Yoram Kluger  6 , Ernest E Moore  7 , Andrew B Peitzman  8 , Rao Ivatury  9 , Raul Coimbra  10 , Gustavo Pereira Fraga  11 , Bruno Pereira  11 , Sandro Rizoli  12 , Andrew Kirkpatrick  13 , Ari Leppaniemi  14 , Roberto Manfredi  1 , Stefano Magnone  1 , Osvaldo Chiara  15 , Leonardo Solaini  1 , Marco Ceresoli  1 , Niccolò Allievi  1 , Catherine Arvieux  16 , George Velmahos  17 , Zsolt Balogh  18 , Noel Naidoo  19 , Dieter Weber  20 , Fikri Abu-Zidan  21 , Massimo Sartelli  22 , Luca Ansaloni  1
Affiliations
Review

Pelvic trauma: WSES classification and guidelines

Federico Coccolini et al. World J Emerg Surg. .

Abstract

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

Keywords: ABO; Angiography; External fixation; Guidelines; Injury; Internal fixation; Management; Mechanic; Pelvic; Pelvic ring fractures; Preperitoneal pelvic packing; REBOA; Trauma; X-ray.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Young and Burgees classification for skeletal pelvic lesions
Fig. 3
Fig. 3
Pelvic Trauma management algorithm (*: patients hemodynamically stable and mechanically unstable with no other lesions requiring treatment and with a negative CT-scan, can proceed directly to definitive mechanical stabilization. MTP: Massive Transfusion Protocol, FAST-E: Eco-FAST Extended, ED: Emergency Department, CT: Computed Tomography, NOM: Non Operative Management, HEMODYNAMIC STABILITY is the condition in which the patient achieve a constant or an amelioration of blood pressure after fluids with a blood pressure >90 mmHg and heart rate <100 bpm; HEMODYNAMIC INSTABILITY is the condition in which the patient has an admission systolic blood pressure <90 mmHg, or > 90 mmHg but requiring bolus infusions/transfusions and/or vasopressor drugs, or admission base deficit (BD) >6 mmol/l, or shock index > 1, or transfusion requirement of at least 4–6 Units of packed red blood cells within the first 24 h)
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