Elzik Mark E, Dirschl Douglas R, Dahners Laurence E
School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
J Trauma. 2008 Aug;65(2):436-41. doi: 10.1097/TA.0b013e31817c5554.
To analyze whether hematogenous marrow bleeding is the major source of hemorrhage after fractures of the pelvic ring.
Retrospective cohort study.
Academic Level I trauma center.
Three hundred seven consecutive pelvic ring injuries from January 1, 2000 to December 31, 2003 were evaluated. After exclusion for age, significant nonpelvic hemorrhage sources, and delayed transfer to this institution, 72 patients remained.
Pelvic injuries were classified as fractures, fracture dislocations, or pure dislocations. These classifications were correlated to change in hematocrit between assumed preinjury and final hematocrit readings, correcting for blood transfused.
The dislocation group had a greater change in hematocrit than the fracture group (2.1%), though not statistically significant. No significant correlations were found between change in hematocrit and length of fracture lines.
Pelvic fracture surfaces may be sources of bleeding in pelvic injuries, but the fact that bleeding is similar in fractures and dislocations indicates fracture surfaces do not constitute the primary source. Based on our analysis one cannot reliably predict pelvic hemorrhage based on A/P radiograph assessments, such as fracture type.
