Pelvic trauma : WSES classification and guidelines

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.Peer reviewe

Paramedics' perceptions and experiences of pelvic injuries in prehospital situations

In recent years there has been an increase in pelvic injuries due to an increase in road traffic collisions (RTCs) (Chesters 2017). Two thirds of pelvic injuries are due to RTCs and the remainder are made up of pedestrian collisions, motorcycle accidents and falls from heights. Patients with fatal pelvic injuries more than likely die of exsanguinations and/or associated severe injuries (ibid.). Lee & Porter (2007) undertook a literature review to analyse the current practice of assessing and managing pelvic injuries in pre-hospital situations. They write that the mortality rates of patients with pelvic fractures are estimated between 7% and 19%, upon their arrival at hospital. The mortality rates of patients with ‘open book’ fractures can be as high as 50%. An ‘open book’ fracture can be defined as any serious fracture that causes the pelvic ring to open like a book. This is commonly seen in anterior injuries to the pelvis widening the pubic symphysis (Gerecht, Larrimore & Steuerwald 2014). Lee and Porter (2007) argue that paramedics can help reduce the retroperitoneal space that a patient can haemorrhage into, and therefore lower the mortality rates for patients with ‘open-book’ pelvic fractures. Given the high mortality rates associated with pelvic injuries and the role paramedics can play in reducing these outcomes, the aim of this narrative review is to synthesize existing literature about pelvic injury recognition, assessment and management in pre-hospital situations. The authors will also conclude upon any new insights or recommendations found following the review

The High Luminosity LHC interaction region magnets towards series production

The High Luminosity Large Hadron Collider (HL-LHC) is the new flagship project of CERN. First endorsed in 2013 and approved in 2016, HL-LHC is an upgrade of the accelerator aiming to increase by a factor of ten the statistics of the LHC collisions at the horizon of 2035-2040. HL-LHC relies on cutting edge technologies: among them, large aperture superconducting magnets will replace the present hardware to allow a smaller beam size in two interaction points (IPs). The project involves the construction of about 150 magnets of six different types: the quadrupole triplet, two main dipoles and three orbit correctors. The triplet, manufactured at CERN and in the USA, will consist of 30 magnets based on Nb3Sn technology, with an operational peak field of 11.4 T. These will be the first quadrupole Nb3Sn magnets installed in a particle accelerator. The other five types of magnets, all relying on Nb-Ti technology, present non-trivial challenges in the design and construction; they will be manufactured as part of in-kind contribution under the responsibility of institutes in Japan, China, Spain, and Italy. The project is now in the phase of transition between qualification through short models and prototypes and the beginning of the series construction. In this paper we review the magnet requirements, the reasons for selecting the design, the technological challenges with respect to previous projects, and we summarize the steps that have been taken to validate the baseline