Concomitant external and internal hemorrhage: Challenges to managing patients with open pelvic fracture

Chih Yuan Fu, Ruo Yi Huang, Shang Yu Wang, Chien Hung Liao, Jen Fu Huang*, Yu Pao Hsu, Chia Yun Lin, Shih Ching Kang

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

15 Scopus citations

Abstract

Introduction: Managing patients with open pelvic fractures continues to be challenging and requires a multidisciplinary approach. In this study, we examined the characteristics of patients with open pelvic fractures and strategies for managing such patients. Materials and methods: The records of patients with open pelvic fractures from January 2010 to August 2016 were retrospectively reviewed. Emergency surgery was performed to control hemorrhaging in patients with an active external hemorrhage. Transcatheter arterial embolization (TAE) was used for definitive hemostasis. The relation between cause of death and timing of death was examined. We also compared the characteristics of surviving and non-surviving patients. Furthermore, patients who received both surgery and post-operative TAE were analyzed in detail. Results: In total, 42 patients with open pelvic fractures were enrolled in the study. The overall mortality rate among patients with open pelvic fractures was 26.2%. Patients whose deaths were related to hemorrhaging and associated injuries died significantly earlier than patients whose deaths were related to sepsis and multiple organ failure (1.3 days vs. 12.3 days, p < 0.001). Sixteen patients (38.1%) received TAE for hemostasis, and their systolic blood pressure (SBP) improved significantly following TAE (from 88.4 mm Hg to 111.6 mm Hg, p < 0.05). In the patients who received both surgery and post-operative TAE (n = 8), the SBP increased significantly after surgery (from 58.8 mm Hg to 81.1 mm Hg, p < 0.05). Similarly, the patients’ SBP after TAE was significantly higher than their post-operative SBP (110.5 mm Hg vs. 81.1 mm Hg, p < 0.05). Conclusion: Active external hemorrhaging was initially controlled when managing patients with open pelvic fractures; however, most patients also required TAE for definitive hemorrhage control. Early TAE should be considered due to the high probability of concomitant internal and external hemorrhage. Close observation and further infection control are important following the hemostatic procedure.

Original languageEnglish
Pages (from-to)1937-1942
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume36
Issue number11
DOIs
StatePublished - 11 2018

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Inc.

Keywords

  • External hemorrhage
  • Internal hemorrhage
  • Open pelvic fracture

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