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Factors Affecting Hemodynamic Instability in Patients with Pelvic Bone Fracture  

Park, Seung Min (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Lee, Kang Hyun (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Choi, Han Ju (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Park, Kyung Hye (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Kim, Sang Chul (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Kim, Hyun (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Hwang, Sung Oh (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Publication Information
Journal of Trauma and Injury / v.21, no.1, 2008 , pp. 22-27 More about this Journal
Abstract
Purpose: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. Methods: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. Results: The mean age of the patients was $48.8{\pm}18.7$, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was $7.5{\pm}8.7days$ in intensive care and $55.1{\pm}47.9days$ in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). Conclusion: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.
Keywords
Pelvic bone fracture; Hemodynamic instability;
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Times Cited By KSCI : 1  (Citation Analysis)
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1 Moreno C, Moore EE, Rosenberger A, Cleveland HC. Hemorrhage associated with major pelvic fracture: a multi speciality challenge. J Trauma 1986;26:987-94   DOI   PUBMED
2 Slatis P, Karaharju EO: External fixation of unstable pelvic fractures, Clin orthop 1980;171:73-8
3 Burgess Ar, Eastridge BJ, Young JWR, Ellison TS, Ellison PS Jr., Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30:848-56   DOI   PUBMED
4 Yellin AE, Lundell CJ, Finck RJ. Diagnosis and control of post traumatic pelvic hemorrhage : Transcatheter angiographic embolization techniques. Arch Surg 1983;118:1378-83   DOI   PUBMED   ScienceOn
5 Ellison M, Timberlake GA, Kerstein MD. Importance following pelvic fracture. J Trauma 1988;28:695-6   DOI
6 Tomkins RG, McCabe CJ, Burke JF, Keating MA, Wright CD. Rectal necrosis after pelvic crush injury. J Trauma 1988;28:697-9   DOI
7 Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop 1980;151:12-23
8 Conolly WB, Hedberg EA. Observations on fractures of the pelvis. J Trauma 1969;9:104-11   DOI   PUBMED
9 Margolies MN, Ring EJ, Waltman AC, Kerr WS Jr, Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med 1972;287:317-21   DOI   PUBMED   ScienceOn
10 Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orhop Clin North Am 1987;18:25-41
11 Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury 1996;27:13-20   DOI   ScienceOn
12 Young JWR, Burgess AR, Brumback RJ, Poka A. Lateral compression fractures of the pelvis : The importance of plain radiographs for the diagnosis and surgical management. Skeletal Radiol 1986;15:103-4   DOI
13 Andrew R. burgess, Brain J. eastridge. Pelvic ring disruptions: Effective classification system and treatment protocol. J Trauma 1990;30:848-56   DOI   PUBMED
14 Kim SJ, Chung HK, Lee KH, Chung ST. A clinical study of the pelvic bone fracture. J Korean Orthop Assoc 1991;26:1441-9
15 Jr. PM, Welch TJ. Hemorrhage in major pelvic fracture. Surg Clin N am 1988;68:757-73   DOI
16 Jho J, Park CS, Yoo BD, Lee DP. Pelvic fracture classification, associated injury and hemodynamic change. J Kor Soc Emerg Med 1999;10:413-20
17 Latenser BA, Gentilello LM, Tarver A, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable fractures. J Trauma 1991;31:28-31   DOI   PUBMED
18 Sanchez-Tocino JM, Turegano-Fuentes F, Perez-Diaz D, Sanz-Sanchez M, Lago-Oliver J, Zorrilla-Ortuzar J, et al. Severe pelvic fractures, associated injuries and hemodynamic instability: incidence, management and outcome in our center. Cir Esp 2007;81:316-23   DOI
19 Gylling SF, Ward RE, Holcroft JW, Bray TJ, Chapman MW. Immediate external fixation of unstable pelvic fracture. Am J Surg 1985;150:721-4   DOI   ScienceOn
20 Peltier LF. Complications associated with fractures of the pelvis. J Bine Joint Surg 1965;47:1060-9   DOI
21 Mark D. Gilliland, Richard E. Ward, Ron M. Barton. Factors affecting mortality in pelvic fractures. J Trauma 1982;22:691-3   DOI   PUBMED
22 Kim JR, Kim SG. Prediction of intra abdominal injury in patients with pelvic bone fracture. J Korean Soc Traumatol 1993;6:185-90
23 Kim SJ, Chung HK, Lee KH, Chung ST. A clinical study of the pelvic bone fracture. J Korean Orthop Assoc 1991;26:1441-9
24 Colapinto V. Trauma to the pelvis : Urethral injury. Clin Orhthop 1980;151:46-55
25 Jeremy W. R. Young and Charles S. Resnik. Fracture of the pelvis: current concepts of classification. AJR 1990;155:1169-75   DOI   PUBMED   ScienceOn
26 Mucha P jr., Farnell MB. Analysis of pelvic fracture management. J Trauma 1984;24:386-7
27 Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989;29:981-1000   DOI   PUBMED
28 Evers BM, Cryer HM, Miller FB. Pelvic fracture hemorrhage. Priorities in management. Arch Srug 1989;124:422-4   DOI   ScienceOn
29 Murr PC, Moore EE, Lipscomb R, Johnston RM. Abdominal trauma associated with pelvic fracture. J Trauma 1980;20:919-23   DOI   PUBMED