Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Comparisons of Fracture Types and Pelvic Angiographic Findings in Hemodynamically Unstable Pelvic Bone Fracture

혈역학적으로 불안정한 골반골 골절 환자에서 골반골 골절 소견과 혈관조영술 소견의 비교

  • Lee, Kwon Il (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Lee, Kang Hyun (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Kang, Sung Chan (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Park, Sung Min (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Jang, Yong Su (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Shin, Tae Yong (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Hwang, Sung Oh (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University) ;
  • Kim, Hyun (Departments of Emergency Medicine Wonju College of Medicine, Yonsei University)
  • 이권일 (연세대학교 원주의과대학 응급의학과) ;
  • 이강현 (연세대학교 원주의과대학 응급의학과) ;
  • 강성찬 (연세대학교 원주의과대학 응급의학과) ;
  • 박승민 (연세대학교 원주의과대학 응급의학과) ;
  • 장용수 (연세대학교 원주의과대학 응급의학과) ;
  • 신태용 (연세대학교 원주의과대학 응급의학과) ;
  • 황성오 (연세대학교 원주의과대학 응급의학과) ;
  • 김현 (연세대학교 원주의과대학 응급의학과)
  • Received : 2007.04.18
  • Accepted : 2007.05.11
  • Published : 2007.06.30
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Abstract

Purpose: Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings. Methods: We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile's classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings. Results: In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: ${\pm}20.1$). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery. Conclusion: The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings.

Keywords

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