Last posts on pelvis2024-03-28T15:51:40+01:00All Rights Reserved blogSpirithttps://www.hautetfort.com/https://www.hautetfort.com/explore/posts/tag/pelvis/atom.xmlMédecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlExaminer un bassin: Peu faible en préhospitaliertag:citerahiadesgenettes.hautetfort.com,2019-07-24:61664162019-07-24T23:28:14+02:002019-07-24T23:28:14+02:00 Clinical Examination of the Pelvic Ring in the Prehospital Phase....
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Clinical Examination of the Pelvic Ring in the <span class="highlight">Prehospital</span> Phase.</span></h1><div class="auths" style="text-align: center;"><a href="https://www.researchgate.net/profile/Bas_Wageningen/publication/333303727_Clinical_Examination_of_the_Pelvic_Ring_in_the_Prehospital_Phase/links/5d11de6d92851cf440494ee5/Clinical-Examination-of-the-Pelvic-Ring-in-the-Prehospital-Phase.pdf?_sg%5B0%5D=vIwEw3epvB4PF1lcKoZNMxFpplvfCb4go2htjsGOiBg91YAsGPZ0u0P3ERhPeRh86ca9gmv6TK7hq6AxRG_Aag.rK0q7vvQRagmf9b0LlhpvCR5I4hxzv28lwpvrTSl9fW61BzT0WUTGajKZg1vX59lr59Zq-Ll7VlVTF6kFE4wMw&_sg%5B1%5D=XYmLET2xVEW3_JoIMRiscYFGst3GKAElF_D_P1f7LM3FdqwHz5lrurC3NdrwoUCS1tK7lN6QmNoren6tleicXx9ZqU-r9-gr-4M30mW1fTKO.rK0q7vvQRagmf9b0LlhpvCR5I4hxzv28lwpvrTSl9fW61BzT0WUTGajKZg1vX59lr59Zq-Ll7VlVTF6kFE4wMw&_iepl=" target="_blank" rel="noopener"><span style="font-size: 10pt;"><span style="font-family: arial, helvetica, sans-serif;">Van Leent EAP et Al. <span role="menubar">Air Med J.</span> 2019 Jul - Aug</span>;38(4):294-297.</span></a></div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;"><span style="font-size: 10pt;">------------------------</span></div><div class="auths" style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">Bien que ce travail soit réalisé sur des trauma fermés, il milite pour un emploi systématiques des ceintures pelviennes dès lors qu'il existe la notion de trauma à haute énergie</span></div><div class="auths" style="text-align: center;"><span style="font-size: 10pt;">------------------------</span></div><div class="afflist"><h3> </h3></div><div class="abstr"><div class=""><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">INTRODUCTION:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Instable pelvic fractures are associated with significant <span class="highlight">hemorrhage</span> and shock. Instability of the pelvic ring should be tested with the manual compression test (MCT) and instable pelvic ring fractures should prompt mechanical stabilization. However, the accuracy of the <span class="highlight">prehospital</span> MCT in patients, that sustained a high energetic trauma, is still unknown.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">SETTING:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Radboudumc Nijmegen, level 1 trauma center, the Netherlands.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">METHODS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">This prospective blind observational study included all patients after a high impact blunt trauma treated by an experienced Helicopter Emergency Medical Service (HEMS) physician. Nominal arranged questionnaires were filled in by the HEMS physician prior to the radiological examination of the patient.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">We included 56 patients of which 11 sustained a pelvic ring fracture. 13 patients were treated with pelvic compression devices, of which only five patients had a pelvic ring fracture. <span class="highlight">Prehospital</span> performed clinical examination by the HEMS physicians had an overall sensitivity of 0.45 (95% CI 0.16-0.75) and a specificity of 0.93 (95% CI 0.29-0.96).</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSION:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong><span style="background-color: #ffff99;">Pelvic ring instability cannot accurately be diagnosed in the</span> <span class="highlight">prehospital</span> setting, based on the MCT.</strong> <span style="background-color: #ffff99;"><strong>The use of the pelvic binder should standard in high impact blunt trauma patients,</strong></span> independently of the MCT or trauma mechanism.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlEt pourquoi pas un ballonet pré-pelvien ?tag:citerahiadesgenettes.hautetfort.com,2019-01-23:61232622019-01-23T20:08:00+01:002019-01-23T20:08:00+01:00 Minimally invasive preperitoneal balloon tamponade and abdominal aortic...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Minimally invasive preperitoneal balloon tamponade and abdominal aortic junctional tourniquet versus open packing for pelvic fracture-associated hemorrhage: Not all extrinsic compression is equal.</span></h1><div class="auths" style="text-align: center;"><span style="font-size: 10pt;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/30633092" target="_blank" rel="noopener noreferrer"><span style="font-family: arial, helvetica, sans-serif;">Do WS et Al. J Trauma Acute Care Surg. 2019 Jan 10. doi: 10.1097/TA.0000000000002203 </span></a></span></div><p style="text-align: center;">--------------------------------------------------------</p><p style="text-align: justify;">On propose souvent la réalisation d'une hémostase temporaire par a pose de sondes à ballonet. Ce travail (<a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1097%2FTA.0000000000001262" target="_blank" rel="noopener noreferrer">partiellement déjà présenté en 2016</a>) rapporte une expérience de ce type avec un produit initialement dédié à la chirurgie pariétale herniaire. La simplicité de sa pose et son efficacité semblent prometteurs du moins chez le cochon.</p><p style="text-align: center;">--------------------------------------------------------</p><p style="text-align: justify;"> </p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BACKGROUND:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Minimally invasive preperitoneal balloon tamponade (PPB) and abdominal aortic junctional tourniquets (AAJT) have been proposed as alternatives to open preperitoneal packing (OP) for the management of pelvic fracture-associated hemorrhage.</strong> We hypothesized that the <strong>PPB (SpaceMaker Pro) and AAJT would result in similar rates of survival and blood loss versus OP</strong> METHODS: 32 swine underwent creation of a combined open-book pelvic fracture and major iliac vascular injuries. Animals were randomized to no intervention (n=7), OP (n=10), PPB (n=9), or AAJT (n=6) at a mean arterial pressure <40 mmHg following initiation of uncontrolled hemorrhage. Survival (up to 60 min + 10 min after intervention reversal), hemodynamics, extraperitoneal pressures, blood loss, and associated complications were compared between groups.</span></p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="https://s3-us-west-2.amazonaws.com/medassist/products/photos/000/000/040/original/spacemaker-plus-dissector-system.jpeg?1547996744" alt="spacemaker-plus-dissector-system.jpeg?1547996744" width="246" height="246" /></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Prior to injury, no difference was measured between groups for weight, hemodynamics, lactate, and hematocrit (all p>0.05). The injury was uniformly lethal without intervention, with survival time (mean) of 5 min, peak preperitoneal pressure (PP) of 14 mmHg, blood loss of 960 g, and peak lactate of 2.6 mmol/L. <span style="background-color: #ffff99;"><strong>Survival time was 44 min with OP vs. 60 min with PPB and AAJT</strong></span> (p<0.01). Peak PP (mmHg) was 19 with OP, 23 with PPB, and 23 with AAJT (p>0.05). Blood loss (g) was 850 with OP, 930 with PPB, and 600 with AAJT (p>0.05). Peak lactate (mmol/L) was 3.3 with OP, 4.3 with PPB, and 6.3 with AAJT (p<0.01). <span style="background-color: #ffff99;"><strong>Only 33% of AAJT animals survived intervention reversal vs. 60% for OP and 67% for PPB</strong></span> (p<0.01). Necropsy revealed bowel/bladder injury in 50% of AAJT subjects vs. 0% in all other arms (p<0.01).</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSIONS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">PPB is a safe and potentially effective alternative to OP for the management of lethal pelvic fracture-associated hemorrhage. <span style="background-color: #ffff99;"><strong>AAJT offers a similar survival benefit to PPB but has concerning rates of ischemia-reperfusion and compressive abdominal organ injury.</strong></span></span></p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlStabilisation pelvienne:tag:citerahiadesgenettes.hautetfort.com,2014-09-23:54538222014-09-23T21:24:00+02:002014-09-23T21:24:00+02:00 Les attelles de type Sam Splint sont INCONTOURNABLES en médecine...
<p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Les attelles de type Sam Splint sont <strong>INCONTOURNABLES</strong> en médecine militaire comme on peut le voir dans une <a href="http://www.sammedical.com/wp-content/uploads/products/sam_splint/documents/Spl-506-bro-MIL-3_313.pdf" target="_blank">brochure spécifique</a>. Certains proposent de l'utiliser comme base d'une stabilisation pelvienne.</span></p><p><iframe width="471" height="265" style="display: block; margin-left: auto; margin-right: auto;" src="http://www.youtube.com/embed/kstf4Pa3AbU" frameborder="0" allowfullscreen=""></iframe></p><p> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlStabilisation pelvienne: Simple est efficacetag:citerahiadesgenettes.hautetfort.com,2013-11-01:52108542013-11-01T19:01:00+01:002013-11-01T19:01:00+01:00 Comparison of circumferential pelvic sheeting versus the T-POD on...
<p style="text-align: center;"><strong><span style="font-family: arial,helvetica,sans-serif; font-size: medium;"> Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability</span></strong><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/23810452" target="_blank"><em><span style="font-family: arial,helvetica,sans-serif; font-size: small;">Prasarn ML et All. <span>Injury.</span> 2013 Jun 27. pii: S0020-1383(13)00256-8</span></em></a></p><p><span style="font-family: arial,helvetica,sans-serif; font-size: small;"><strong>Objectives:</strong> Commercially available binder devices are commonly used in the acute treatment of pelvic fractures, while many advocate simply placing a circumferential sheet for initial stabilization of such injuries. We sought to determine whether or not the T-POD would provide more stability to an unstable pelvic injury as compared to circumferential pelvic sheeting.</span><br /><span style="font-family: arial,helvetica,sans-serif; font-size: small;"><strong>Methods:</strong> Unstable pelvic injuries (OTA type 61-C-1) were surgically created in five fresh, lightly</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> embalmed whole human cadavers. Electromagnetic sensors were placed on each hemi-pelvis. The</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> amount of angular motion during testing was measured using a Fastrak, three-dimensional,</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). Either a T-POD or</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> circumferential sheet was applied in random order for testing. The measurements recorded in this</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> investigation included maximum displacements for sagittal, coronal, and axial rotation during</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> application of the device, bed transfer, log-rolling, and head of bed elevation.</span><br /><span style="font-family: arial,helvetica,sans-serif; font-size: small;"><strong>Results:</strong> There were no differences in motion of the injured hemi-pelvis during application of either the</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> T-POD or circumferential sheet. During the bed transfer, log-rolling, and head of bed elevation, there</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> were no significant differences in displacements observed when the pelvis was immobilized with either</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> a sheet or pelvic binder (T-POD).</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/00/2028493058.jpg" target="_blank"><img id="media-4310072" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/1312028850.jpg" alt="pelvis" /></a></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/02/46604925.jpg" target="_blank"><img id="media-4310103" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/02/2174873079.jpg" alt="pelvis" /></a></p><p style="text-align: justify;"><span style="font-family: arial,helvetica,sans-serif; font-size: small;"><strong>Conclusions: <span style="background-color: #ffff99;">A circumferential pelvic sheet is more readily available, costs less, is more versatile, and is</span></strong></span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"><strong><span style="background-color: #ffff99;"> equally as efficacious at immobilizing the unstable pelvis as compared to the T-POD.</span></strong> We advocate the</span><span style="font-family: arial,helvetica,sans-serif; font-size: small;"> use of circumferential sheeting for temporary stabilization of unstable pelvic injuries.</span></p><p style="text-align: justify;"><span style="font-family: arial,helvetica,sans-serif; font-size: small;"><br /></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlStabilisation pelvienne: Un état des lieux à liretag:citerahiadesgenettes.hautetfort.com,2012-11-24:49072792012-11-24T08:49:00+01:002012-11-24T08:49:00+01:00 The use of pelvic binders in the emergent management of potential pelvic...
<h1 class="svTitle" style="border: 0px; font-size: 1.4em; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; color: #5c5c5c; line-height: 1.5em; clear: both; font-family: 'Arial Unicode MS', 'Arial Unicode', Arial, 'URW Gothic L', Helvetica, Tahoma, sans-serif;">The use of pelvic binders in the emergent management of potential pelvic trauma</h1><p style="text-align: center;">Chesser TJS et all. Injury, Int. J. Care Injured 43 (2012) 667–669</p><p style="text-align: center;"><a id="media-3851319" href="http://citerahiadesgenettes.hautetfort.com/media/02/01/802139756.pdf">PelvicBinder.pdf</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlStabilisation pelvienne: Au bon niveautag:citerahiadesgenettes.hautetfort.com,2011-11-20:38756862011-11-20T11:38:27+01:002011-11-20T11:38:27+01:00 Ce document est à mettre en lien avec l'impotrance d'un positionnement...
<p style="text-align: justify;">Ce document est à mettre en lien avec l'impotrance d'un positionnement correct de ces dispositifs. Il s'agit seulement d'une fois sur 2 d'un positionnement au niveau des grands trochanter. Dans près de 40% des cas le positionnement était trop haut.</p><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Accurate%20placement%20of%20a%20pelvic%20binder%20improves%20reduction%20of%20unstable%20fractures%20of%20the%20pelvic%20ring" target="_blank">Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. Bonner TJ et all. J Bone Joint Surg Br. 2011 Nov;93(11):1524-8.</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlStabilisation pelvienne: Sam Sling, Tpod ou autre chose ?tag:citerahiadesgenettes.hautetfort.com,2011-11-20:38756742011-11-20T11:36:00+01:002011-11-20T11:36:00+01:00 Une présentation d'une publication portant sur la comparaison du T Pod, de...
<p style="text-align: justify;">Une présentation d'une publication portant sur la comparaison du T Pod, de la Sam Pelvic sling et du Pelvic binder qui sont les 3 dispositifs les plus couramment utilisés.</p><p style="text-align: center;"><a id="media-3301803" href="http://citerahiadesgenettes.hautetfort.com/media/00/02/103496151.pdf">StabPelv.pdf</a></p><p style="text-align: center;"><a href="http://www.medicalsca.com/files/jb__js_-_pelvic_devices_comparison_-_highlights.pdf" target="_blank">http://www.medicalsca.com/files/jb__js_-_pelvic_devices_comparison_-_highlights.pdf</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPelvic Fracture Hemorrhage—Update and Systematic Reviewtag:citerahiadesgenettes.hautetfort.com,2011-11-20:38755812011-11-20T09:47:00+01:002011-11-20T09:47:00+01:00...
<p style="text-align: center;"><a href="http://www.east.org/Content/documents/practicemanagementguidelines/PelvicPMG_Updated-Pub_Dec2011.pdf" target="_blank">http://www.east.org/Content/documents/practicemanagementguidelines/PelvicPMG_Updated-Pub_Dec2011.pdf</a></p>