Browse > Article

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

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)
Publication Information
Journal of Trauma and Injury / v.20, no.1, 2007 , pp. 26-32 More about this Journal
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
Pelvic bone; Angiography; Embolization; Hemorrhagic shock;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Velmahos GC, Demetriades D, Chahwan S. Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. Am J Surg 1999; 178:367-73   DOI   PUBMED   ScienceOn
2 Ertel W, Keel M, Eid K, Platz A, Trentz O. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 2001;15:468-74   DOI   ScienceOn
3 Eastridge BJ, Starr A, Minei JP, O'Keefe GE. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma 2002;53:446-51   DOI   ScienceOn
4 Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed JF III Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 1997:43:395-9   DOI   ScienceOn
5 Dalal SA, Burgess AR, Siegel JH. Pelvic fracture in multiple trauma: classification by mechanism in key to pattern of organ injury, resuscitative requirements and outcome. J Trauma 1989:29:981-1002   DOI   PUBMED
6 Rommens PM, Gerck E, Hansen M, Hessmann MH. Mortality, Morbidity and functional outcome after open book and lateral compression lesions of the pelvic ring. a retrospective analysis of 100 type B pelvic ring lesions according to Tile's classification. Unfallchirurg 2003;106:542-9   DOI   ScienceOn
7 Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts arterial hemorrhage. ANZ J Surg 2000;70:338-43   DOI
8 Poole GV, Ward EF. Causes of mortality in patients with pelvic fractures. Orthopedics 1994;17:691-6   PUBMED
9 Velmahos GC, Chahwan S, Falabella A, Hanks SE, Demetriades D. Angiographic embolization for intraperitoneal and retroperitoneal injuries. World J Surg 2000;24:539-45   DOI   ScienceOn
10 Starr AJ, Griffin DR, Reinert CM, Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma 2002;16:553-61   DOI   ScienceOn
11 Fangio P, Asehnoune K, Edouard A, Smail N, Benhamou D. Early embolization and vasopressor administration for management of life-threatening hemorrhage from pelvic fracture. J Trauma 2005;58:978-84   DOI   ScienceOn
12 Mucha P, Farnell MB. Analysis of pelvic fracture management. J Trauma 1984;24:379-86   DOI   PUBMED
13 George CV, Konstantinos GT, Pantelis V, Grant S, Linda SC, et al. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 2002:52:303-8
14 Eastridge BJ, Burgess AR. Pedestrian pelvic fractures: 5 year experience of a major urban trauma center. J Trauma 1997;42:695-700   DOI   ScienceOn
15 Gurevitz S, Bender B, Tytiun Y, Velkes S, Salai M, Stein M. The role of pelvic fractures in the course of treatment and outcome of trauma patients. IMAJ 2005;7:623-26
16 Burgess AR, Eastridge BJ, Young JWR. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30:848-56   DOI   PUBMED
17 Wong YC, Wang LJ, Ng CJ, Tseng IC, See LC. Mortality after successful transcatheter arterial embolisation in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor. J Trauma 2000;49:71-5   DOI   ScienceOn
18 Rothenberger D, Velasco R, Strate R, Fischer RP, Perry JF Jr, Open pelvic fracture: a lethal injury. J Trauma 1978;18:184-7   DOI   PUBMED
19 Trunkey DD, Chapman MW, Lim RC Jr., Dunphy JE. Management of pelvic fractures in blunt trauma injury. J Trauma 1974;14:912-23   DOI   PUBMED
20 Riemer BL, Butterfield SL, Diamond DL,. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma 1993;35:671-7   DOI   PUBMED
21 Young JWR, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986;160:445-51   DOI   PUBMED
22 Velmahos GC, Chahwan S, Hanks SE. Angiographic embolization of bilateral internal iliac arteries to control lifethreatening hemorrhage after blunt trauma to the pelvis. Am Surg 2000;66:858-62   PUBMED
23 Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts arterial haemorrhage. Aust N Z J Surg 2000;70:338-43   DOI   PUBMED
24 Perez JV, Hughes TM, Bowers K. Angiographic embolisation in pelvic fracture. Injury 1998;29:187-91   DOI   ScienceOn
25 Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts pelvic arterial haemorrhage. Aust NZ J Surg 2000;70:338-43   DOI
26 Poole GV, Ward EF, Muakkassa FF. Pelvic fracture from major blunt trauma: outcome is determined by associated injuries. Ann Surg 1991;213:532-9   DOI   PUBMED   ScienceOn
27 Bassam D, Cephas GA, Ferguson KA, Beard LN, Young JS. A protocol for the initial management of unstable pelvic fractures. Am Surg 1998;64:862-7   PUBMED
28 Evers BM, Cryer HM, Miller FB. Pelvic fracture hemorrhage Priorities in management. Arch Surg 1989;124:422-4   DOI   PUBMED   ScienceOn
29 Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC. External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma 2003;54:437-43   DOI   ScienceOn