PELVIC FRACTURE PATTERNS AND THEIR CORRESPONDING ANGIOGRAPHIC SOURCES OF HEMORRHAGE

Participants: C.M. Metz, D.J. Hak, J.A. Goulet, D. Williams

Keywords: pelvic fracture, angiographic sources of hemorrhage

Materials and Methods

Forty-nine patients with pelvic ring fractures who underwent pelvic angiography for hemodynamic instability or persistent blood loss were retrospectively reviewed. Angiographic findings were correlated with pelvic radiographs using both the Young and Burgess and the Orthopaedic Trauma Association (OTA) classifications. Data regarding age, sex, Injury Severity Score (ISS), mechanism of injury, hemodynamic parameters, initial resuscitation transfusion requirements and patient survival was analyzed.

Results

Twenty-one patients had anteroposterior compression (APC) fracture patterns. This group had the highest average ISS (thirty-seven), the highest average transfusion requirement of twenty-nine units packed red blood cells (PRBC) and the highest mortality rate (thirty-three percent). Seventy-one percent were hemodynamically unstable on initial presentation. There were two internal iliac artery injuries and six superior gluteal artery injuries. Posterior division injuries (ten) were twice as common as anterior division injuries (five).

Twenty-seven patients had lateral compression (LC) fracture patterns. They had an average ISS of twenty-eight and average transfusion requirement of thirteen units of PRBC. Fifty-six percent of patients were hemodynamically unstable on initial presentation. Five of these patients died (nineteen percent). There were three internal iliac artery injuries. Anterior division injuries (twenty-two) were more common than posterior division injuries (five). Most commonly injured vessels were the pudendal artery which was injured in nine patients and the obturator artery which was injured in seven patients.

One patient sustained a vertical shear (VS) fracture pattern and had no identifiable source of angiographic bleeding.

Conclusion

Arteriographic evidence of a bleeding source was present in a high percentage of APC type fractures and in LC type fractures with complete or partial instability of the posterior pelvic ring (OTA classification Type B or C). Angiographic evaluation and resuscitation with blood should be considered in any of these patients with hemodynamic instability.