Potentially serious adverse effects from the application of
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Pelvic circumferential compression devices (PCCDs) have gained wide acceptance in the management of patients with pelvic fracture. These devices are considered safe due to their noninvasive nature and significant hazards associated with the use of PCCDs have not been reported previously.

A 17-year-old boy sustained a pelvic fracture with left acetabular fracture, splenic rupture, intraperitoneal bladder rupture, and left renal laceration after a fall from height. A SAM-Sling® was immediately applied in the hybrid ER due to signs of hemodynamic instability. Subsequently, selective embolizations of the right superior gluteal artery left lateral sacral artery, and a posterior branch of the left renal artery was performed. After angioembolization, splenectomy and repair of the bladder were performed in the operation room.

The PCCD was applied for 14 h until physiological status stabilized and the coagulation profile normalized. Serum creatine kinase levels subsequently showed a gradual increase, peaking at 39,386 IU/L on post-injury day 5. The patient underwent contrast-enhanced CT 8 days after injury, revealing muscle necrosis bilaterally on the anterior side of the pelvis. No angioembolization had been performed for this area. Retrospectively, the position of the PCCD on the initial CT and the distribution of muscle necrosis on the second CT was reconstructed on 3-dimensional images.

These revealed that muscle necrosis completely matched the position of the PCCD. Due to the high risk of surgical site infection, open reduction of the anterior side of the pelvis was avoided, and internal fixation was delayed until post-injury day 15. The patient underwent percutaneous screw fixation, achieving bone union without infection. He ultimately returned to daily activities with moderate walking disability and muscle weakness of flexors and abductors of the hip.

Source: https://www.sciencedirect.com/science/article/pii/S2352644020300169
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