Blood loss in pelvic ring fractures: CT-based estimation

Abstract

Background:The main cause of mortality after pelvic ring fractures is the acute haemorrhagic shock. The aim of the study was to estimate blood loss using CT and to correlate estimated blood loss to the mortality.Methods: A retrospective analysis of 42 patients with AO/OTA C-type pelvic ring fractures was performed.In total 29 AO/OTA C1-type, 4 C2-type and 9 C3-type fractures were analysed. A CT-volumetric analysis was developed to estimate the early blood loss in the different compartments. The results were correlated to the mortality of the patients.Results: Significant increases in interstitial free blood volume (392±502.8 vs. 888±663; P<0.05) and total blood loss (476±535 vs. 1,005±649; P<0.05) were seen when comparing C1 to C3-type fractures. Early blood loss significantly correlated to mortality. No significant difference was seen between all groups with respect to systolic blood pressure, haemoglobin concentration and the Injury Severity Score (ISS). Conclusions:In pelvic ring fractures the CT-estimated blood loss correlates to mortality.

The Association between BMI, Days Spent in Hospital, Blood Loss, Surgery Time and Polytrauma Pelvic Fracture—A Retrospective Analysis of 76 Patients

“…Additionally, LC III fractures were shown to require over 105% of blood units transferred (0.7 units vs. 1.5 units) compared to LC II fractures. Veith et al presented, in their study, that the level of free blood volume found during the CT scan increases with the level of instability of the pelvic ring fracture in the AO/OTA C-types [26]. Not only does this support our findings, but it also indicates the importance of a thorough initial examination in order to establish the injury and associated injuries.…”

“…Having said that, it is essential to acknowledge that the greater the displacement of the pelvic ring fracture, the higher the chance of severe bleeding and associated abdominal injuries [22,27]. The severity of the bleeding increasing with the instability of the pelvis is believed to be associated with the disruption of the sacral venous plexus and arterial branches of iliac vessels and the high amount of cancellous bone [26,27]. The presented results are in line with current knowledge that pelvic ring fractures can be mortal injuries that may require rapid intervention [14,[28][29][30].…”

Commentary: Meta-Analysis of 3D Printing Applications in Traumatic Fractures

“…Given that patients are followed in the post-operative period, it may be possible to quantify return to function via measures such as force exerted via the joint repaired. In addition, one potential excellent outcome which may have been alluded to was decreased intraoperative blood loss compared to the traditional cohort, which is commonly used to as a parallel correlate to how invasive a procedure was ( 15 ). Moreover, from a clinical perspective, it is worth noting that the findings of this meta-analysis, while extremely sound, should ought to be used with additional considerations specific to the patient.…”