Preoperative Blood Loss of Isolated Acetabular Fractures

Abstract

Objective:To quantify preoperative blood loss in isolated acetabular fractures and identify any fracture or patient characteristics associated with increased blood loss or blood transfusion.Design:Retrospective cohort study.Setting:Two level 1 trauma centers.Patients/Participants:All patients with operative, isolated acetabular fractures from January 2010 to December 2018.Intervention:Operative management of an acetabular fracture.Main Outcome Measurements:Volume of preoperative blood loss and transfusion rates associated with isolated acetabular fracture patterns.Results:A total of 598 patients were included. The mean preoperative blood loss of all fractures was 1172.6 mL. The 3 fracture patterns with the greatest average preoperative blood loss were associated both column (1454.9 mL), T-type (1374.8 mL), and anterior column posterior hemitransverse fractures (1317.7 mL). The acetabular fracture pattern had a significant association with preoperative blood loss and preoperative transfusion. The timing from injury to surgery and body mass index were significantly associated with preoperative blood loss.Conclusions:In conclusion, operatively treated isolated acetabular fractures surprisingly lose an average of greater than 1 liter of blood in the preoperative setting. Surgeons must carefully assess patient's physiology, ensuring they are adequately resuscitated before surgery and remain aware that increasing body mass index is associated with increased preoperative blood loss. However, as patients await surgery, unreduced acetabular fractures continue to contribute to ongoing blood loss beyond the first 24 hours from injury. We believe the best hemostasis after initial resuscitation is provided by surgical reduction and fixation, and we recommend a continued early surgical intervention to prevent continued bleeding from fracture surfaces.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Early Treatment of Acetabular Fractures via an Anterior Approach Increases Blood Loss but not Packed Red Blood Cell Transfusion

“…Both formulas rely on objective measures such as the patient's sex, height, weight, PRBC transfusions given, and preoperative and postoperative Hgb or hematocrit (Hct) levels. 15,16…”

“…Both formulas rely on objective measures such as the patient's sex, height, weight, PRBC transfusions given, and preoperative and postoperative Hgb or hematocrit (Hct) levels. 15,16 Previous studies have shown no difference in EBL with early surgery (24-48 hours) compared with delayed surgery for acetabular fractures; however, one of these studies only used patients with a posterior approach and the other consisted of more than half the patients with a posterior approach used. 10,11 Another study showed that, compared with .48 hours after admission, earlier surgery through an AIP was not associated with increased surgical EBL or intraoperative PRBC transfusion.…”

“…A recent study showed that operatively treated isolated acetabular fractures lose on average ;1.2 L of blood preoperatively. 16 The authors of that study conclude that once a patient is appropriately resuscitated, early surgical intervention might be the best method for decreasing ongoing blood loss from the acetabular fracture. Although preoperative blood loss was not measured, our results would agree and suggest that early surgery is not associated with clinically relevant blood loss leading to PRBC transfusion, but the increased blood loss should be considered in some patient scenarios (eg, polytrauma).…”

“…Multiple methods for evaluating the outcome of blood loss were investigated, including EBL, calculated blood loss (CBL, using both the Gross and Hemoglobin [Hgb]-balance equations, see Appendix, Supplemental Digital Content 1, http://links.lww. com/JOT/C72, for formulas), 15,16 and packed red blood cell (PRBC) transfusion requirements (both intraoperative and postoperative). It was assumed 1-unit PRBC transfusion is 300 mL.…”

Functional Outcome of Surgically Managed Acetabular Fractures

“…One of the dangerous trauma is the injury to the pelvis which can cause fracture of the acetabulam and if the patient is not resuscitated, s/he may die of blood loss. So management of acetabulam fracture needs priority in trauma patients [3].…”