Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Characteristics of Stable Pelvic Bone Fractures with Intra-abdominal Solid Organ Injury

복부 고형장기 손상을 동반한 안정 골반골 골절의 특성

  • Park, Sang-June (Department of Emergency Medicine Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sun-Hyu (Department of Emergency Medicine, College of Medicine, University of Ulsan) ;
  • Lee, Jong-Hwa (Department of Radiology Ulsan University Hospital, College of Medicine, University of Ulsan) ;
  • Ahn, Ryeok (Department of Emergency Medicine, Ulsan University College of Medicine, University of Ulsan) ;
  • Hong, Eun-Seog (Department of Emergency Medicine, Ulsan University College of Medicine, University of Ulsan)
  • 박상준 (서울아산병원 응급의학과) ;
  • 김선휴 (울산대학교병원 응급의학과) ;
  • 이종화 (울산대학교병원 영상의학과) ;
  • 안력 (울산대학교병원 응급의학과) ;
  • 홍은석 (울산대학교병원 응급의학과)
  • Received : 2010.05.19
  • Accepted : 2010.12.13
  • Published : 2010.12.30
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Abstract

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

Keywords

References

  1. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma 2003;54:52-9. https://doi.org/10.1097/00005373-200301000-00007
  2. Poletti PA, Wintermark M, Schnyder P, Becker CD. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol 2002;12:969-78. https://doi.org/10.1007/s00330-002-1353-y
  3. Self ML, Blake AM, Whitley M, Nadalo L, Dunn E. The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. Am J Surg 2003;186:609-13. https://doi.org/10.1016/j.amjsurg.2003.08.003
  4. Shanmuganathan K, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology 1999;212:423-30. https://doi.org/10.1148/radiology.212.2.r99au18423
  5. Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with "normal" chest radiograph? J Trauma 2001;51:1173-6. https://doi.org/10.1097/00005373-200112000-00025
  6. Ali J, Ahmadi KA, Williams JI. Predictors of laparotomy and mortality in polytrauma patients with pelvic fractures. Can J Surg 2009;52:271-6.
  7. Gustavo Parreira J, Coimbra R, Rasslan S, Oliveira A, Fregoneze M, Mercadante M. The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury 2000;31:677-82. https://doi.org/10.1016/S0020-1383(00)00074-7
  8. Lunsjo K, Tadros A, Hauggaard A, Blomgren R, Kopke J, Abu-Zidan FM. Associated injuries and not fracture instability predict mortality in pelvic fractures: a prospective study of 100 patients. J Trauma 2007;62:687-91. https://doi.org/10.1097/01.ta.0000203591.96003.ee
  9. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986;160:445-51. https://doi.org/10.1148/radiology.160.2.3726125
  10. Deunk J, Brink M, Dekker HM, Kool DR, van Kuijk C, Blickman JG, et al. Routine versus selective computed tomography of the abdomen, pelvis, and lumbar spine in blunt trauma: a prospective evaluation. J Trauma 2009;66:1108-17. https://doi.org/10.1097/TA.0b013e31817e55c3
  11. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006;141:468-73. https://doi.org/10.1001/archsurg.141.5.468
  12. Grieshop NA, Jacobson LE, Gomez GA, Thompson CT, Solotkin KC. Selective use of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. J Trauma 1995;38:727-31. https://doi.org/10.1097/00005373-199505000-00008
  13. Garber BG, Bigelow E, Yelle JD, Pagliarello G. Use of abdominal computed tomography in blunt trauma: do we scan too much? Can J Surg 2000;43:16-21.
  14. Bode PJ, Edwards MJ, Kruit MC, van Vugt AB. Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am J Roentgenol 1999;172:905-11. https://doi.org/10.2214/ajr.172.4.10587119
  15. Richards JR, Derlet RW. Computed tomography and blunt abdominal injury: patient selection based on examination, haematocrit and haematuria. Injury 1997;28:181-5. https://doi.org/10.1016/S0020-1383(96)00187-8