title: Evaluation of pelvic fracture stability and the need for angioembolization: pelvic instabilities on plain film have an increased probability of requiring angioembolization.
abstract: BACKGROUND
  The use of pelvic x-rays (PXRs) as an early diagnostic adjunct in the evaluation of blunt trauma patients has become widely accepted, and computed tomographic (CT) scanning is now used universally in the assessment of abdominal and pelvic injuries. In this study, we have attempted to identify patients with pelvic fractures who might be at risk for vessel hemorrhage and determine if early angioembolization was required in these patients.
  
  
  METHODS
  We retrospectively reviewed patients who presented with pelvic fractures from June 2005 to August 2007. Both PXRs and CT scans were reviewed. Patients who presented with bleeding due to other associated injuries or who did not receive a CT scan were excluded. Patients with either initial hemodynamic instability or contrast extravasation on enhanced CT scan underwent angioembolization. Patient demographics, Injury Severity Score, the amount of blood transfused, and the relationship between the fracture pattern and angioembolization were analyzed.
  
  
  RESULTS
  A total of 54 patients were enrolled. A diagnosis of an unstable pelvic fracture on PXR was associated with a higher probability of angioembolization. Seven patients received incompatible diagnoses from the PXR and CT scan; these patients received larger amounts of transfused blood and demonstrated an increased need for angioembolization.
  
  
  CONCLUSIONS
  Although CT scan is more sensitive in the identification of acetabular or small pelvic fractures, PXR is sufficient for the early evaluation of pelvic fracture stability. Based on the current series, early angioembolization is suggested for patients with an initial diagnosis of an unstable pelvic fracture. In addition, patients receiving large amounts of transfused blood are more likely to require early angioembolization.
authors.affiliation: Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Ping-Kuei
authors.initials: PK
authors.lastname: Chung
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
mesh_terms: D000077:Acetabulum / Q000293:injuries; D000328:Adult; D001803:Blood Transfusion; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging*; D006465:Hemoperitoneum / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging*