Pelvic fracture pattern does not always predict the need for urgent embolization

Abstract

Background: The intimate relationship between the pelvis and related vasculature can lead to life-threatening arterial hemorrhage after blunt trauma. Unfortunately, hemorrhage related to pelvic fracture is often associated with other serious injuries, complicating clinical decision making. Previous clinical reviews have associated fracture geometry with arterial hemorrhage, specifically implicating those injuries with evidence of major ligamentous disruption (MLD).

Methods: We analyzed pelvic fractures for evidence of a relationship between MLD and the need for angiographic embolization. Our trauma registry was reviewed from 1996 to 2002; 283 patients with pelvic fractures arrived in the emergency department with a systolic blood pressure < or = 90 mmHg. MLD was defined as anteroposterior compression types II and III, lateral compression type III, combined mechanism, and vertical shear according to the Young-Burgess classification.

Results: Thirty-seven (13%) of the patients studied required angiographic embolization for control of pelvic hemorrhage. The pelvic fracture pattern (MLD vs. non-MLD) did not differ significantly between the embolized and nonembolized groups. The predictive value of other variables varied by gender. Age had a significant correlation with the need for embolization in women, whereas Injury Severity Score did not. Conversely, age had no predictive value for men, whereas Injury Severity Score had a significant correlation.

Conclusion: The findings in this study suggest that pelvic fracture pattern does not consistently correlate with the patient's need for urgent embolization and should not be used as the sole determinant for angiography. Furthermore, variables such as age and gender should be further investigated, as they may potentially have a predictive value in this clinical setting.