Page 40 - Journal of Special Operations Medicine - Winter 2014

Imaging Comparison of Pelvic Ring Disruption and
Injury Reduction With Use of the Junctional Emergency

Treatment Tool for Preinjury and Postinjury Pelvic Dimensions:
A Cadaveric Study With Computed Tomography

Joshua L. Gary, MD; Manickam Kumaravel, MD;
Keith Gates, MD; Andrew R. Burgess, MD; Milton L. Routt, MD;
Timothy Welch; Jeanette M. Podbielski; Angela M. Beeler; John B. Holcomb, MD

ABSTRACT
Objective: Complex dismounted blast injuries from Keywords: open book pelvis, pelvic binder, wounds and in-
(improvised) explosive devices have caused amputa- juries, junctional hemorrhage, combat casualty care, pelvic
tions of the lower extremities associated with open ring disruption and injury, APC III injuries
injuries to the pelvic ring, resulting in life-threatening
hemorrhage from disruption of blood vessels near the
pelvic ring. Provisional stabilization of the skeletal pel-
vis by circumferential pelvic compression provides sta- Introduction
bility for intrapelvic clots and reduces the volume of Pelvic ring injuries have been identified as a risk fac-
the pelvis, thereby limiting the amount of hemorrhage. tor for mortality in a civilian trauma population. 1,2
The Junctional Emergency Treatment Tool (JETT ; Life-threatening hemorrhage associated with pel-
™
™
North American Rescue Products, http://www.narescue vic ring disruption results from disruption of blood
.com) is a junctional hemorrhage control device devel- vessels near the pelvic ring following blunt trauma.
oped to treat pelvic and lower extremity injuries sus- Provisional stabilization of the skeletal pelvis by cir-
tained in high-energy trauma on the battlefield and in cumferential pelvic compression is thought to provide
the civilian environment. Our purpose was to evaluate stability for an intrapelvic clot and to reduce the vol-
the compressive function of the JETT in the reduction ume of the pelvic ring, thereby limiting the size of the
of pelvic ring injuries in a cadaveric model. Methods: hemorrhage. 3
Radiographic comparison of pre (intact) and post
pelvic ring disruption and injury was compared with The military experience with pelvic ring disruptions
radiographic measurements post reduction with the during the recent conflicts in Afghanistan and Iraq
JETT device in two cadavers. The device’s ability to has been far different from the civilian experience, as
reduce pelvic disruption and injury in a human cadaver blast injuries from (improvised) explosive devices have
model was assessed through measurements of the an- caused amputations of the lower extremities associated
teroposterior (AP) and transverse diameters obtained with open injuries to the pelvic ring. Early tourniquet
at the inlet and outlet of the pelvis. Results: Computed use with traumatic amputations has been shown to de-
tomography (CT) scans demonstrated that JETT ap- crease mortality in the military population ; however,
4
plication effectively induced circumferential soft tissue with traumatic amputations in the proximal thigh, tour-
compression that was evoked near anatomic reduction niquet placement is difficult or impossible. For these
of the sacroiliac joint and symphysis pubis. Conclu- reasons, the JETT was developed to control bleeding
sions: The JETT is capable of effectively reducing an from the external iliac or common femoral arteries with
AP compression type III injury (APC III) pelvic ring direct pressure rather than circumferential compression
disruption and injury by approximating the inlet and of the extremity. The JETT can also provide circumfer-
outlet dimensions toward predisruption measurements. ential pelvic compression. (The JETT is US Food and
Such a degree of reduction suggests that the JETT de- Drug Administration [FDA] approved for the control of
vice may be suitable in the acute setting for provisional junctional hemorrhage but is not yet FDA approved as a
pelvic stabilization. pelvic stabilization device.)

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