Pelvic fracture pattern predicts pelvic arterial haemorrhage.
BACKGROUND
The association between pelvic fracture pattern and the need for pelvic arterial embolization remains controversial. To address this issue, a study of the experience at Auckland Hospital was undertaken.


METHODS
Review was undertaken of a trauma database, blood bank database, patient records and pelvic radiographs. Of the 364 pelvic fracture patients admitted over a 4-year period, 76 were transfused with 6 or more units of blood in the first 24 h and these constitute the study population.


RESULTS
Embolized patients were older (median age 42 vs 29.5 years; P < 0.05) and had a higher abbreviated injury score for the pelvic girdle (median 3 vs 2; P < 0.05) compared to non-embolized patients. Revised trauma score (median 7.69 vs 7.55), injury severity score (median 29 vs 30.5), morbidity (55 vs 39%) and mortality (45 vs 32.1%) rates did not differ significantly between embolized and non-embolized groups, respectively. The median blood transfusion requirement in the first 6 h from injury was 14 units in embolized and 8 units in non-embolized patients (P = 0.005). Embolization was required in 12 of 27 (44.4%) patients with fracture patterns indicative of major pelvic ligament disruption, whereas seven of 38 (18.4%) patients without these fracture patterns required embolization (P < 0.05).


CONCLUSIONS
The need for pelvic embolization correlated with fracture patterns that indicated major ligament disruption, although the relationship was not sufficiently strong to warrant change to current indications for pelvic angiography.
Hamill
J
J
Trauma Services, Auckland Hospital, New Zealand. ianc@ahsl.co.nz
Holden
A
A
Paice
R
R
Civil
I
I
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001803:Blood Transfusion; D019992:Databases as Topic; D004621:Embolization, Therapeutic; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D005544:Forecasting; D050723:Fractures, Bone / Q000145:classification*; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D015601:Injury Severity Score; D008022:Ligaments / Q000293:injuries; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors