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External Fixation to Control Hemorrhage

- See:
    - External Fixators for Pelvic Frx

- Discussion:
    - see: vascular injuries in pelvic frx;
    - theory is that the mobile, sharp edges of frx lead to dislodgment of clotted blood and renewed bleeding;
    - open book pelvic frx (APC II and APC III) are most amenable to application of external fixation for reduction of blood loss;
           - lateral compression injuries or internal rotatory injuries are typically associated with less bleeding.

- Timing for Application of Fixator:
    - question is when to apply Ex Fix when exploratory laparotomy is planned for intraperitoneal hemorrhage due to pelvic frx;

- Arguements Against Emergent Application of Ex Fix:
    - there is scant definative evidence to confirm reduction of blood loss after placement of Ex Fix;
    - external fixation will not reduce bleeding from arterial disruption or from coagulopathy

Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation.

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