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Predicting blood loss in isolated pelvic and acetabular high-energy trauma
Robert A Magnussen1, Marc A Tressler, William T Obremskey
1Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Nashville, Tennessee 37232-8774, USA.
Objective:
To quantify transfusion requirements in patients with isolated acetabular or pelvic fractures and correlate these requirements with fracture classification.
Design:
Retrospective review of 382 patients with isolated pelvic and/or acetabular fractures.
Setting:
Academic Level I Trauma Center.
Patients/Participants:
Patients were identified from a trauma registry. Appropriate radiographs and complete transfusion data were obtained for 289 (75%) of 382 eligible patients between January 1, 1998 and December 31, 2003.
Intervention:
Classification of pelvic fracture by Young and Burgess type and acetabular fractures by Letournel type.
Main Outcome Measurement:
Number of units of blood transfused in the first 24 hours after admission to the trauma center.
Results:
Patients with isolated pelvic fractures with major ligament disruption (APC II or III, LC III, vertical shear, or combined mechanisms) were more likely to receive a blood transfusion (44%) than other fracture types (8.5 %) (P < 0.0005). Transfusion amounts were greatest in APC III (12.6 units) and vertical shear (4.6 units) injuries. Fractures classified as both column, anterior column, anterior column posterior hemi-transverse, or T type were more likely to receive a blood transfusion (56%) than other fracture types (28%) (P = 0.003). Of these fracture types, both column (8.8 units) and anterior column posterior hemi-transverse (6.4 units) received the largest transfusions.
Conclusions:
Patients with isolated acetabular fractures are as likely as those with isolated pelvic fractures to receive blood transfusions within the first 24 hours of admission. Higher energy pelvic ring fractures classified as APC II or III, LC III, vertical shear, or combined mechanism require more frequent transfusion than other pelvic fractures. Acetabular fractures involving the anterior column as well as T-type fractures require more frequent blood transfusions than other acetabular fractures.
