Clinically relevant bleeding risk in low-energy fragility fractures of the pelvis in elderly patients

Low-energy fragility fractures of the pelvis (FFP) are an underestimated entity, yet increasing in incidence. The bleeding risk for pelvic fractures in high-energy trauma is well known, resulting in adequate treatment guidelines and clear protocols. This is not the case for FFPs but this risk is presumably low. This study aims to investigate the clinically relevant bleeding risk, in patients older than 50 years with a fragility fracture of the pelvis admitted to the emergency department (ED).

A retrospective cohort study was conducted of consecutive patients aged over 50 years with a FFP due to low-energy trauma (LET) presented to the ED of a single trauma center (North-West Clinics in Alkmaar, The Netherlands) between January 2018 and August 2022. The primary outcome was the percentage of patients requiring blood transfusion, or invasive procedures such as coiling by the interventional radiologists or damage control surgery, due to bleeding. Secondary outcomes were the mean decrease of hemoglobin and mortality.

In total, 322 consecutive patients with a mean age of 80 years of which 84% female were included. In total 66% was admitted to the hospital and seven patients underwent surgical intervention. Three cases (0.9%) of potentially clinically relevant bleeding were observed. These three cases needed a blood transfusion, without other interventions, and were all admitted with a low hemoglobin level without signs of hemodynamic instability. No invasive interventions were noted.

The risk of bleeding in FFP's is very low with very few patients requiring blood transfusions (< 1%) and with no invasive interventions due to bleeding. Since the risk of clinically relevant bleeding is low, the significance of repeated Hb checks and CECT may be questionable. The effect of these diagnostics in case of absence of hemodynamic instability and above borderline normal Hb levels needs to be investigated in further studies.