OTA 2006 Posters
Scientific Poster #60 Pelvis
Predicting Blood Loss in Patients with Isolated Pelvic and
Acetabular Fractures
Marc A. Tressler, DO (n); Robert Magnussen, MD (n);
Richard Miller, MD (n); Philip J. Kregor, MD (n);
William R. Obremskey, MD (n);
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Purpose: The aim of this study was to provide more defined blood
loss expectations in the isolated pelvic and/or acetabular trauma patients.
Methods: After obtaining IRB approval, a retrospective review of
the trauma registry was undertaken to identify patients with isolated pelvic
or acetabular fractures treated at a single university medical center between
1999 and 2003. 390 patients were identified. To be included in the cohort,
patients could not have any additional long bone fractures, chest or abdominal
injuries with an Abbreviated Injury Score of >2, or any other organ system
injury that required operative intervention. Complete diagnostic studies
were available for 365 patients. The pelvic fractures were classified using
the Young-Burgess
Classification. The acetabular fractures were classified using the Letournel
system. Blood volume and transfusion data from the first 24 hours following
admission was correlated with the various fracture patterns.
Results: 27/111 (24%) patients with isolated pelvic fractures required
a transfusion in the first 24 hours. The average units transfused was 3.97
(range, 1-51) for pelvic fractures. Table 1 shows a breakdown of pelvic
fracture patterns and their associated blood loss. 50/143 (35%) patients
with isolated acetabular fractures were transfused on hospital day one.
The average units transfused was 4.67 (range, 2-13) for acetabular fractures.
Table 2 shows a breakdown of acetabular fracture patterns and their associated
blood loss. Patients who sustained injuries to both the pelvic ring and
the acetabulum were not more likely to require blood products than patients
with an isolated pelvis or acetabulum.
Conclusions: Although previous classification systems have been utilized
to predict morbidity and mortality associated with high-energy pelvic and acetabular
trauma, to our knowledge this is the first study to predict blood product
requirements in isolated fractures of the pelvis and acetabulum.
The most striking datum was the mean blood loss in APC 3 pelvic fractures
of 12.6 units. The both-column and anterior column-posterior hemitransverse
pattern acetabular fractures should also be seen as "pelvic bleeders",
based on volume and frequency of bleeding, respectively.
Significance: This information can be utilized in the acute setting
to better manage patient resuscitation, predict transfusion needs, and possibly
assist in a decision-making process related to angiography.
Table 1 Pelvic Fracture Bleeding
| Type |
# Injuries |
# Transfused |
% Transfused |
Mean Units
Transfused |
| APC 1 |
2 |
1 |
50.0 |
2.00 |
| APC 2 |
12 |
4 |
33.3 |
3.50 |
| APC 3 |
8 |
5 |
62.5 |
12.6 |
| CM |
15 |
5 |
33.3 |
2.20 |
| LC 1 |
50 |
3 |
6.0 |
2.67 |
| LC 2 |
7 |
1 |
14.3 |
3.00 |
| LC 3 |
5 |
3 |
60.0 |
4.00 |
| VS |
12 |
5 |
41.7 |
4.60 |
Table 2 Acetabular Fracture Bleeding
| Type |
# Injuries |
# Transfused |
% Transfused |
Mean Units
Transfused |
| AW |
2 |
0 |
0 |
0.00 |
| AC |
2 |
1 |
50.0 |
4.00 |
| PW |
48 |
8 |
16.7 |
3.13 |
| PC |
0 |
0 |
0 |
0.00 |
| Trans |
3 |
1 |
33.3 |
13.0 |
| ACPHT |
10 |
8 |
0.08 |
6.38 |
| PC-PW |
5 |
2 |
40.0 |
2.00 |
| T-PW |
51 |
20 |
39.2 |
3.65 |
| T-type |
11 |
6 |
54.5 |
4.67 |
| BC |
11 |
4 |
36.4 |
8.75 |
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.