Extraperitoneal pelvic packing in trauma of the pelvis: A standard practice? A general review

Introduction: Pelvis fractures that associate bleeding with hemodynamic instability warrant immediate treatment. The therapeutic options in these cases vary from angioembolization to extraperitoneal pelvic packing.

Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist.

Results: 38 papers were identified. After screening, 27 papers were used to complete the analysis.

Discussion: Frequently, bleeding has a venous source in the pelvis. In the case of pelvic fractures with hemodynamic instability, extraperitoneal pelvic packing is one of the core treatments but not a stand-alone treatment, as it needs to be coupled with a pro-efficient trauma resuscitation protocol. Its intended use is as a bridge therapy until conclusive investigations regarding the place of bleeding can be obtained. Angiography is recommended if hemodynamic instability exists after pelvic packing and effective hemodynamic resuscitation.

Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients and large multicentric studies.