Журнал травм и лечения

Therapeutic Strategy In Polytrauma: Two Cases Of Unstable Pelvic Fractures With Traumatic Aortic Injury

Abstract

Tatsuma Fukuda, Toshiaki Mochizuki, Norio Otani, Takehiro Matsubara, Naoki Yahagi and Shinichi Ishimatsu

In life-threatening poly trauma, there is no defined therapeutic guidelines. We present optimal therapeutic strategy of life-threatening unstable pelvic fractures with traumatic aortic injury. Two cases of identical life-threatening poly trauma, unstable pelvic fractures with traumatic aortic injury, were taken to our emergency and critical care center. They were performed radical treatment for the unstable pelvic fractures before performing radical surgery for the aortic injury. The radical treatment for the unstable pelvic fractures included preventive TAE, which was performed regardless of the presence of extravasation. In the period leading up to the surgery for aortic injury, we conducted strict medical management of blood pressure and pulse using beta blockers and calcium channel blockers. By means of this strategy, we were able to perform early (18 hours after the accident in case 1, 14 hours after the accident in case 2), safe blood vessel prosthesis implantation for aortic injury with the use of a cardiopulmonary bypass without difficult-to-control massive hemorrhaging due to intra-operative use of heparin. Their postoperative progresses were favorable, and they continued recovering until they could resume activities of daily living with complete independence without obvious complications resulting from TAE. In cases of life-threatening pelvic fracture with concomitant traumatic aortic injury that require surgery with the use of cardiopulmonary bypass, early and safe operation on the aorta is made possible by performing pre-operative preventive TAE, regardless of the presence of extravasation. We consider this strategy will contribute to improved survival rates.