Uso combinado de Reboa, Embolización y Fijación Precoz en Fracturas Inestables de Pelvis

Carlos Agustín  David Parrales; Lisseth Alejandra Moreira Véliz; Hector Emanuel Avila Malo; Luis Fernando Corales Martinez; Carlos Jonnathan Cuzco Guillermo

doi:10.70577/asce.v5i3.1020

Authors

Carlos Agustín David Parrales Investigador Independiente https://orcid.org/0009-0001-6332-4219
Lisseth Alejandra Moreira Véliz Universidad de las Américas https://orcid.org/0000-0002-6946-5880
Hector Emanuel Avila Malo Investigador Independiente https://orcid.org/0009-0007-5922-7751
Luis Fernando Corales Martinez Investigador independiente https://orcid.org/0009-0008-6079-9463
Carlos Jonnathan Cuzco Guillermo Investigador independiente https://orcid.org/0009-0002-0921-7487

DOI:

https://doi.org/10.70577/asce.v5i3.1020

Keywords:

Fractures; REBOA; Embolization, Therapeutic; Fracture Fixation, Internal; Multiple Organ Failure; Necrosis; Hemorrhage Control; Resuscitation.

Abstract

Unstable pelvic ring fractures associated with exsanguinating hemorrhage constitute one of the most lethal traumatic emergencies, with mortality rates reaching 40-60%. Early hemorrhage control through combined strategies may reduce multiple organ failure and soft tissue necrosis. To evaluate the effectiveness of the combined use of REBOA (resuscitative endovascular balloon occlusion of the aorta), selective embolization, and early internal fixation in reducing multiple organ failure and soft tissue necrosis in patients with unstable pelvic ring fractures. Systematic review and meta-analysis conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and Cochrane Library were searched (January 2000-February 2026). Studies evaluating combined hemorrhage control strategies in unstable pelvic fractures were included. Methodological quality was assessed using ROBINS-I and Cochrane RoB-2. Results: A total of 856 records were identified, of which 32 studies met inclusion criteria (n=4,123 patients). Implementation of REBOA as a bridge to definitive hemostasis was associated with a 48% reduction in transfusion requirements (p<0.001) and a decrease in exsanguination mortality from 38% to 19% (OR: 0.41; 95% CI: 0.29-0.58). The combination of selective embolization and early external fixation reduced the incidence of multiple organ failure from 32% to 16% (p<0.001). Soft tissue necrosis decreased from 24% to 9% with combined strategies (OR: 0.32; 95% CI: 0.20-0.51). Time to definitive fixation <24 hours was associated with shorter ICU stay (11 vs 20 days, p<0.001). A staged integrated management algorithm is proposed. Multicenter randomized trials are needed to establish the optimal sequence of interventions. The combined strategy integrating REBOA as a rescue measure, selective embolization for arterial control, and early internal fixation significantly reduces mortality, multiple organ failure, and soft tissue necrosis in unstable pelvic fractures.

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