Which pelvic ring fractures are potentially lethal?

Ruatti, Sébastien; Guillot, S. Segado; Brun, Julien; Thony, F.; Bouzat, Pierre; Payen, Jean François; Tonetti, Jérôme

doi:10.1016/j.injury.2015.01.041

Cited by 66 publications

(28 citation statements)

References 26 publications

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“…Although the anatomical fracture pattern is no doubt an important component determining the likelihood of significant vascular injury, the utility of the YB and Tile classification systems in predicting the need for blood transfusion and angiography in the initial resuscitation phase has shown mixed results [8][9][10][11]. There have been several studies supporting their predictability, but these results could not be consistently replicated across all of the studies [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

Cheng

Tee

et al. 2020

Preprint

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Background: The most common cause of death in cases of pelvic trauma is exsanguination caused by associated injuries but not the pelvic injury per se. For patients with relatively isolated pelvic trauma, the impact of the vascular injury severity on the outcome remains unclear. We hypothesized that, in addition to the fracture pattern complexity, the severity of the pelvic vascular injury plays a more decisive role in the outcome. Methods: The medical records of patients with pelvic fracture at a single center between Jan 2016 and Dec 2017 were retrospectively reviewed. Those with an abbreviated injury scale (AIS) score ≥3 in areas other than the pelvis were excluded. Lateral compression (LC) type 1 fractures and anteroposterior compression (APC) type 1 fractures according to the Young-Burgess classification and ischial fractures were defined as simple pelvic fractures, while other fracture types were considered complicated pelvic fractures. Based on CT, the vascular injury severity was defined as minor (fracture with or without hematoma) or severe (hematoma with contrast pooling/extravasation). The patient demographics, clinical parameters, and outcome measures were compared between the groups. Results: Twenty-six of the 155 patients had a severe vascular injury. Those with severe vascular injuries had poorer hemodynamics, a higher injury severity score (ISS), required more blood transfusions, and had a longer ICU stay (3.81 vs. 0.86 days, p=0.000) and total hospital stay (20.7 vs. 10.1 days, p=0.002) than those with minor vascular injuries. In contrast, those with complicated pelvic fractures (LC II/III, APC II/III, vertical shear and combined type fracture) required a similar number of transfusions and had a similar length of ICU stay compared to those with simple pelvic fractures (LC I, APC I and ischium fracture), but they had a longer total hospital stay (13.6 vs. 10.3 days, p=0.034). These findings were similar even if only patients with an ISS >=16 were considered. Conclusions: Our results indicate that even in patients with relatively isolated pelvic injuries, the vascular injury severity is more closely correlated to the outcome than the type of anatomical fracture. Therefore, a more balanced classification of pelvic injury that takes both the fracture pattern and hemodynamic status into consideration, such as the WSES classification, seems to have better utility for clinical practice.

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Section: Introductionmentioning

confidence: 99%

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

Cheng

Tee

et al. 2020

Preprint

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“…Again, significantly less blood product administration was necessary in the first 24-hour postoperative period. Fifteen patients (20%) required repeat packing upon reinspection, with a mean time for packing removal of 2 days (range, [1][2][3][4][5][6][7]. This study further demonstrated no deaths owing to acute blood loss, and with an overall mortality rate of 21%, which was significantly lower than previous mortality rates.…”

Section: Role Of Pelvic Packingmentioning

confidence: 73%

“…These injuries are associated most often with hemodynamic instability, large transfusion requirement on presentation, and death. 6 …”

Section: Classificationmentioning

confidence: 99%

Management of Pelvic Ring Injuries in Unstable Patients

Rudloff

Triantafillou

2016

Orthopedic Clinics of North America

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“…The superiorgluteal artery is often damaged in posterior pelvic ring lesions especially iliac wing fracture, when the artery exits through the greater sciatic notch [5]. Therefore iliac wing fractures with or without pubic symphysis disruptions, can engender massive bleeding on their own [6]. In sacral fractures, the supero-lateral and medium sacral arteries are often damaged [7].…”

Section: Discussionmentioning

confidence: 99%

Pelvic ring fractures in polytrauma patient – a perpetual challenge – four case presentation

Costin¹,

Totan²,

Stănescu³

et al. 2020

Ro Med J.

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In this paper we present a series of four cases of multiple trauma patients that associated pelvic ring fractures. The objective was to show the complexity of this pathology, the therapeutical efforts needed to treat such patients and the very different end results such case may have. Polytrauma is still a serious public health issue because of the increased mortality and morbidity in the young population, which leads to a significant socioeconomic impact.

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Which pelvic ring fractures are potentially lethal?

Cited by 66 publications

References 26 publications

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

Management of Pelvic Ring Injuries in Unstable Patients

Pelvic ring fractures in polytrauma patient – a perpetual challenge – four case presentation

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