Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Surgery
Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

Authors: Fabio Agri, Mylène Bourgeat, Fabio Becce, Kevin Moerenhout, Mathieu Pasquier, Olivier Borens, Bertrand Yersin, Nicolas Demartines, Tobias Zingg

Published in: BMC Surgery | Issue 1/2017

Login to get access

Abstract

Background

Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures.

Methods

Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed.

Results

The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates.

Conclusions

Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.
Literature
1.
Schmal H, Markmiller M, Mehlhorn AT, Sudkamp NP. Epidemiology and outcome of complex pelvic injury. Acta Orthop Belg. 2005;71(1):41–7.PubMed
2.
Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 2009;40(Suppl 4):S53–61.CrossRefPubMed
3.
Costantini TW, Coimbra R, Holcomb JB, Podbielski JM, Catalano RD, Blackburn A, Scalea TM, Stein DM, Williams L, Conflitti J, et al. Pelvic fracture pattern predicts the need for hemorrhage control intervention—results of an AAST multi-institutional study. J Trauma Acute Care Surg. 2017;82(6):1030–8.CrossRefPubMed
4.
Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30(7):848–56.CrossRefPubMed
5.
White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;40(10):1023–30.CrossRefPubMed
6.
Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res. 1980;151:12–21.
7.
Tile M, Pennal GF. Pelvic disruption: principles of management. Clin Orthop Relat Res. 1980;151:56–64.
8.
Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.CrossRefPubMed
9.
Rommens PM, Hessmann MH. Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma. 2002;16(2):92–8.CrossRefPubMed
10.
O'Sullivan RE, White TO, Keating JF. Major pelvic fractures: identification of patients at high risk. J Bone Joint Surg Br. 2005;87(4):530–3.CrossRefPubMed
11.
Lunsjo K, Tadros A, Hauggaard A, Blomgren R, Kopke J, Abu-Zidan FM. Associated injuries and not fracture instability predict mortality in pelvic fractures: a prospective study of 100 patients. J Trauma. 2007;62(3):687–91.CrossRefPubMed
12.
Anandakumar V, Hussein FK, Varuun B, Zhu R. Predictive parameters for angiography and embolization in the bleeding pelvic fracture. J Clin Orthop Trauma. 2013;4(2):70–4.CrossRefPubMedPubMedCentral
13.
Hussami M, Grabherr S, Meuli RA, Schmidt S. Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures. Int J Legal Med. 2016;131(3):731–8.CrossRefPubMedPubMedCentral
14.
Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D, Bathon H. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma. 1989;29(7):981–1000.CrossRefPubMed
15.
Eastridge BJ, Starr A, Minei JP, O'Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53(3):446–50.CrossRefPubMed
16.
Manson T, O'Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J. Young-burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 2010;24(10):603–9.CrossRefPubMed
17.
Karadimas EJ, Nicolson T, Kakagia DD, Matthews SJ, Richards PJ, Giannoudis PV. Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature. Int Orthop. 2011;35(9):1381–90.CrossRefPubMedPubMedCentral
18.
Osterhoff G, Scheyerer MJ, Fritz Y, Bouaicha S, Wanner GA, Simmen HP, Werner CM. Comparing the predictive value of the pelvic ring injury classification systems by tile and by young and burgess. Injury. 2014;45(4):742–7.CrossRefPubMed
19.
Koo H, Leveridge M, Thompson C, Zdero R, Bhandari M, Kreder HJ, Stephen D, McKee MD, Schemitsch EH. Interobserver reliability of the young-burgess and tile classification Systems for Fractures of the pelvic ring. J Orthop Trauma. 2008;22(6):379–84.CrossRefPubMed
20.
Furey AJ, O'Toole RV, Nascone JW, Sciadini MF, Copeland CE, Turen C. Classification of pelvic fractures: analysis of inter- and intraobserver variability using the young-burgess and tile classification systems. Orthopedics. 2009;32(6):401.CrossRefPubMed
21.
Gabbe BJ, Esser M, Bucknill A, Russ MK, Hofstee DJ, Cameron PA, Handley C, de Steiger RN. The imaging and classification of severe pelvic ring fractures: experiences from two level 1 trauma centres. Bone Joint J. 2013;95-B(10):1396–401.CrossRefPubMed
22.
Scheyerer MJ, Osterhoff G, Wehrle S, Wanner GA, Simmen HP, Werner CM. Detection of posterior pelvic injuries in fractures of the pubic rami. Injury. 2012;43(8):1326–9.CrossRefPubMed
23.
Schicho A, Schmidt SA, Seeber K, Olivier A, Richter PH, Gebhard F. Pelvic X-ray misses out on detecting sacral fractures in the elderly - importance of CT imaging in blunt pelvic trauma. Injury. 2016;47(3):707–10.CrossRefPubMed
24.
Berg EE, Chebuhar C, Bell RM. Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms. J Trauma. 1996;41(6):994–8.CrossRefPubMed
25.
Verbeek DOF, Zijlstra IAJ, van der Leij C, Ponsen KJ, van Delden OM, Goslings JC. Predicting the need for abdominal hemorrhage control in major pelvic fracture patients: the importance of quantifying the amount of free fluid. J Trauma Acute Care Surg. 2014;76(5):1259–63.CrossRefPubMed
26.
Toth L, King KL, McGrath B, Balogh ZJ. Efficacy and safety of emergency non-invasive pelvic ring stabilisation. Injury. 2012;43(8):1330–4.CrossRefPubMed
27.
Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surgy Res. 2013;99(2):175–82.CrossRef
28.
Papakostidis C, Kanakaris N, Dimitriou R, Giannoudis PV. The role of arterial embolization in controlling pelvic fracture haemorrhage: a systematic review of the literature. Eur J Radiol. 2012;81(5):897–904.CrossRefPubMed
29.
Lustenberger T, Wutzler S, Störmann P, Laurer H, Marzi I. The role of angio-embolization in the acute treatment concept of severe pelvic ring injuries. Injury. 2015;46:S33–8.CrossRefPubMed
30.
Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma. 2007;62(4):834–9.CrossRefPubMed
31.
Morrison JJ, Galgon RE, Jansen JO, Cannon JW, Rasmussen TE, Eliason JL. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016;80(2):324–34.CrossRefPubMed
32.
Schwartz DA, Medina M, Cotton BA, Rahbar E, Wade CE, Cohen AM, Beeler AM, Burgess AR, Holcomb JB. Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. J Trauma Acute Care Surg. 2014;76(1):134–9.CrossRefPubMed
33.
Tanizaki S, Maeda S, Matano H, Sera M, Nagai H, Ishida H. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min. Injury. 2014;45(4):738–41.CrossRefPubMed
34.
Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AE, Stahel PF. Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury. 2009;40(1):54–60.CrossRefPubMed
35.
Katsura M, Yamazaki S, Fukuma S, Matsushima K, Yamashiro T, Fukuhara S. Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan trauma data Bank. Scand J Trauma Resusc Emerg Med. 2013;21:82.CrossRefPubMedPubMedCentral
36.
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative S. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12(12):1500–24.CrossRefPubMed
37.
American College of Surgeons. ATLS: advanced trauma life support program for doctors (student course manual). 9th ed. Chicago: American College of Surgeons; 2012.
38.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, et al. Fracture and dislocation classification compendium - 2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10):S1–6.CrossRefPubMed
39.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
40.
41.
Bonner TJ, Eardley WG, Newell N, Masouros S, Matthews JJ, Gibb I, Clasper JC. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Joint Surg Br. 2011;93(11):1524–8.CrossRefPubMed
42.
Swartz J, Vaidya R, Hudson I, Oliphant B, Tonnos F. Effect of pelvic binder placement on OTA classification of pelvic ring injuries using computed tomography. Does it mask the injury? J Orthop Trauma. 2016;30(6):325–30.CrossRefPubMed
43.
Vaidya R, Scott AN, Tonnos F, Hudson I, Martin AJ, Sethi A. Patients with pelvic fractures from blunt trauma. What is the cause of mortality and when? Am J Surg. 2016;211(3):495–500.CrossRefPubMed
44.
Knops SP, Van Lieshout EM, Spanjersberg WR, Patka P, Schipper IB. Randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers. Injury. 2011;42(10):1020–6.CrossRefPubMed
45.
Spanjersberg WR, Knops SP, Schep NW, van Lieshout EM, Patka P, Schipper IB. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009;40(10):1031–5.CrossRefPubMed
46.
Croce MA, Magnotti LJ, Savage SA, Wood GW 2nd, Fabian TC. Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg. 2007;204(5):935–9.CrossRefPubMed
47.
El-Haj M, Bloom A, Mosheiff R, Liebergall M, Weil YA. Outcome of angiographic embolisation for unstable pelvic ring injuries: factors predicting success. Injury. 2013;44(12):1750–5.CrossRefPubMed
48.
Hauschild O, Aghayev E, von Heyden J, Strohm PC, Culemann U, Pohlemann T, Suedkamp NP, Schmal H. Angioembolization for pelvic hemorrhage control: results from the German pelvic injury register. J Trauma Acute Care Surg. 2012;73(3):679–84.CrossRefPubMed
49.
Tesoriero RB, Bruns BR, Narayan M, Dubose J, Guliani SS, Brenner ML, Boswell S, Stein DM, Scalea TM. Angiographic embolization for hemorrhage following pelvic fracture: is it “time” for a paradigm shift? J Trauma Acute Care Surg. 2017;82(1):18–26.CrossRefPubMed
Metadata
Title
Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study
Authors
Fabio Agri
Mylène Bourgeat
Fabio Becce
Kevin Moerenhout
Mathieu Pasquier
Olivier Borens
Bertrand Yersin
Nicolas Demartines
Tobias Zingg
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0299-6

Other articles of this Issue 1/2017

BMC Surgery 1/2017 Go to the issue

Technical advance

Application of intraoperative limb-length measurement by a new osteotomy device in hemiarthroplasty for treating femoral neck fracture

Research article

Prognostic significance of perigastric tumor deposits in patients with primary gastric cancer

Research article

The effect of thymoquinone coating on adhesive properties of polypropylene mesh

Technical advance

Use of a hydrophilic coating wire reduces significantly the rate of central vein punctures and the incidence of pneumothorax in totally implantable access port (TIAP) surgery

Research article

A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma

Case report

Obstruction in the third portion of the duodenum due to a diospyrobezoar: a case report