Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Factors Affecting Hemodynamic Instability in Patients with Pelvic Bone Fracture

골반골 골절 환자의 혈역학적 불안정화에 미치는 영향요소

  • Park, Seung Min (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Kang Hyun (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Choi, Han Ju (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Park, Kyung Hye (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Kim, Sang Chul (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Kim, Hyun (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Hwang, Sung Oh (Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University)
  • 박승민 (연세대학교 원주의과대학 응급의학과학교실) ;
  • 이강현 (연세대학교 원주의과대학 응급의학과학교실) ;
  • 최한주 (연세대학교 원주의과대학 응급의학과학교실) ;
  • 박경혜 (연세대학교 원주의과대학 응급의학과학교실) ;
  • 김상철 (연세대학교 원주의과대학 응급의학과학교실) ;
  • 김현 (연세대학교 원주의과대학 응급의학과학교실) ;
  • 황성오 (연세대학교 원주의과대학 응급의학과학교실)
  • Received : 2008.05.23
  • Accepted : 2008.06.15
  • Published : 2008.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. Methods: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. Results: The mean age of the patients was $48.8{\pm}18.7$, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was $7.5{\pm}8.7days$ in intensive care and $55.1{\pm}47.9days$ in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). Conclusion: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.

Keywords

References

  1. Kim SJ, Chung HK, Lee KH, Chung ST. A clinical study of the pelvic bone fracture. J Korean Orthop Assoc 1991;26:1441-9
  2. Evers BM, Cryer HM, Miller FB. Pelvic fracture hemorrhage. Priorities in management. Arch Srug 1989;124:422-4 https://doi.org/10.1001/archsurg.1989.01410040032006
  3. Moreno C, Moore EE, Rosenberger A, Cleveland HC. Hemorrhage associated with major pelvic fracture: a multi speciality challenge. J Trauma 1986;26:987-94 https://doi.org/10.1097/00005373-198611000-00005
  4. Mucha P jr., Farnell MB. Analysis of pelvic fracture management. J Trauma 1984;24:386-7
  5. Murr PC, Moore EE, Lipscomb R, Johnston RM. Abdominal trauma associated with pelvic fracture. J Trauma 1980;20:919-23 https://doi.org/10.1097/00005373-198011000-00001
  6. Jr. PM, Welch TJ. Hemorrhage in major pelvic fracture. Surg Clin N am 1988;68:757-73 https://doi.org/10.1016/S0039-6109(16)44584-6
  7. Slatis P, Karaharju EO: External fixation of unstable pelvic fractures, Clin orthop 1980;171:73-8
  8. Peltier LF. Complications associated with fractures of the pelvis. J Bine Joint Surg 1965;47:1060-9 https://doi.org/10.2106/00004623-196547050-00018
  9. Burgess Ar, Eastridge BJ, Young JWR, Ellison TS, Ellison PS Jr., Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30:848-56 https://doi.org/10.1097/00005373-199007000-00015
  10. Young JWR, Burgess AR, Brumback RJ, Poka A. Lateral compression fractures of the pelvis : The importance of plain radiographs for the diagnosis and surgical management. Skeletal Radiol 1986;15:103-4 https://doi.org/10.1007/BF00350202
  11. Yellin AE, Lundell CJ, Finck RJ. Diagnosis and control of post traumatic pelvic hemorrhage : Transcatheter angiographic embolization techniques. Arch Surg 1983;118:1378-83 https://doi.org/10.1001/archsurg.1983.01390120008004
  12. Sanchez-Tocino JM, Turegano-Fuentes F, Perez-Diaz D, Sanz-Sanchez M, Lago-Oliver J, Zorrilla-Ortuzar J, et al. Severe pelvic fractures, associated injuries and hemodynamic instability: incidence, management and outcome in our center. Cir Esp 2007;81:316-23 https://doi.org/10.1016/S0009-739X(07)71330-1
  13. Andrew R. burgess, Brain J. eastridge. Pelvic ring disruptions: Effective classification system and treatment protocol. J Trauma 1990;30:848-56 https://doi.org/10.1097/00005373-199007000-00015
  14. Kim SJ, Chung HK, Lee KH, Chung ST. A clinical study of the pelvic bone fracture. J Korean Orthop Assoc 1991;26:1441-9
  15. Colapinto V. Trauma to the pelvis : Urethral injury. Clin Orhthop 1980;151:46-55
  16. Ellison M, Timberlake GA, Kerstein MD. Importance following pelvic fracture. J Trauma 1988;28:695-6 https://doi.org/10.1097/00005373-198805000-00026
  17. Tomkins RG, McCabe CJ, Burke JF, Keating MA, Wright CD. Rectal necrosis after pelvic crush injury. J Trauma 1988;28:697-9 https://doi.org/10.1097/00005373-198805000-00027
  18. Kim JR, Kim SG. Prediction of intra abdominal injury in patients with pelvic bone fracture. J Korean Soc Traumatol 1993;6:185-90
  19. Jho J, Park CS, Yoo BD, Lee DP. Pelvic fracture classification, associated injury and hemodynamic change. J Kor Soc Emerg Med 1999;10:413-20
  20. Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop 1980;151:12-23
  21. Jeremy W. R. Young and Charles S. Resnik. Fracture of the pelvis: current concepts of classification. AJR 1990;155:1169-75 https://doi.org/10.2214/ajr.155.6.2122661
  22. Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989;29:981-1000 https://doi.org/10.1097/00005373-198907000-00012
  23. Mark D. Gilliland, Richard E. Ward, Ron M. Barton. Factors affecting mortality in pelvic fractures. J Trauma 1982;22:691-3 https://doi.org/10.1097/00005373-198208000-00007
  24. Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury 1996;27:13-20 https://doi.org/10.1016/S0020-1383(96)90106-0
  25. Conolly WB, Hedberg EA. Observations on fractures of the pelvis. J Trauma 1969;9:104-11 https://doi.org/10.1097/00005373-196902000-00002
  26. Margolies MN, Ring EJ, Waltman AC, Kerr WS Jr, Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med 1972;287:317-21 https://doi.org/10.1056/NEJM197208172870701
  27. Gylling SF, Ward RE, Holcroft JW, Bray TJ, Chapman MW. Immediate external fixation of unstable pelvic fracture. Am J Surg 1985;150:721-4 https://doi.org/10.1016/0002-9610(85)90416-7
  28. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orhop Clin North Am 1987;18:25-41
  29. Latenser BA, Gentilello LM, Tarver A, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable fractures. J Trauma 1991;31:28-31 https://doi.org/10.1097/00005373-199101000-00006