Abstract
Introduction
Massive hemorrhage is often associated with unstable pelvic fractures with posterior
ring injury. Initial pelvic radiography alone may not detect these posterior lesions.
We examined whether the presence of an anterior pelvic fracture on initial pelvic
radiography alone may identify patients who are at a high risk of major hemorrhage.
Materials and methods
A total of 288 patients with pelvic fractures were admitted to the Fukui Prefectural
Hospital during an 11-year period. After excluding 33 patients who were in cardiopulmonary
arrest on arrival and nine with concomitant abdominal organ injuries requiring emergency
laparotomy, 246 eligible patients were retrospectively reviewed. Anterior pelvic fractures
were defined as displacement of the obturator ring, obturator ring with laterality,
or displacement of the pubic symphysis on pelvic radiography.
Results
Massive hemorrhage was identified in 106 of 246 patients. Patients with massive hemorrhage
had a higher frequency of anterior pelvic fractures on pelvic radiography and higher
frequency of posterior pelvic fractures on computed tomography than those without
massive hemorrhage. Logistic regression analysis identified displacement of the obturator
ring by ≥5 mm, obturator ring with laterality of ≥5 mm, and displacement of the pubic symphysis by ≥4 mm on pelvic radiography as predictors of massive pelvic hemorrhage.
Conclusion
The results of the present study suggested that the presence of displaced anterior
lesions of the pelvic ring on pelvic radiography alone, without the use of computed
tomography during the initial treatment stage, may promptly identify patients at high
risk of massive pelvic hemorrhage who require intervention for hemorrhage control.
Keywords
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Article Info
Publication History
Published online: March 22, 2018
Accepted:
March 21,
2018
Received in revised form:
March 20,
2018
Received:
January 22,
2018
Footnotes
☆There are no potential conflicts of interest.
☆☆This paper has not been presented anywhere.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
