Relationship between the pelvic bone marrow dose-volume parameters and acute hematologic toxicity in neoadjuvant pelvic intensity-modulated radiotherapy for local advance rectal cancer / 中华放射医学与防护杂志

Objective:To analyze the correlation between the volume of irradiated pelvic bone marrow and acute hematologic toxicity (HT), in order to provide clinical data to reduce the risk of acute HT and optimize the radiotherapy plan.Methods:From October 2017 to May 2019, 41 LARC patients who received neoadjuvant concurrent chemoradiotherapy (CCRT) were retrospectively reviewed in our center. All patients were treated with 5-field intensity-modulated radiotherapy (IMRT), and the prescription dose delivered to PTV was 45-50.4 Gy in 25-28 fractions. Capecitabine or 5-fluorouracil (5-FU) wasadministered daily 5 days a week during radiotherapy. Different HTswere recorded according to National Cancer Institute Common Toxicity Criteria Version 5.0 (NCI-CTC.V5.0) based on laboratory tests. The volume of PBM or each site (coxal, sacrum, femoral) receiving more than x Gy refers to as TVx, CVx, SVx, and FVx, respectively. Logistic regression was performed to evaluate the association between the volume of irradiated pelvic bone marrow and different HT. Generalized additive model (GAM) and piecewise regression were used to further analyze the possible nonlinear relationship and threshold effect between them. Results:Multivariate logistic regression analysis showed that low-dose of irradiated total pelvic bone marrow volume ( TV5) and coxal bone marrow volume ( CV5, CV10) were significantly correlated with Grade ≥2 leukopenia( P<0.05). There was a significant negative correlation between the sacrum bone marrow volume ( SV5, SV10) and Grade ≥2 leukopenia ( P<0.05). A thresholdeffect has been observed between CV10 and Grade ≥2 leukopenia by Generalized additive model (GAM) and piecewise linear regression. The threshold between CV10 and Grade ≥2 leukopenia was 575 ml, OR (95% CI) was 1.85 (1.08, 3.16). Conclusions:In neoadjuvant IMRT of rectal cancer, CV is a better predictor of acute HT induced by CCRT than TV. The irradiated volume of CV associated with acute HT was mainly low-dose levels ( CV5, CV10). The thresholds of our study ( CV10= 575 ml) could be a good reference for the optimization of the radiotherapy plan.

A prospective study to evaluate pelvic bone mineral density changes in patients of cervical cancer undergoing chemoradiotherapy: study protocol

Background:Cancer treatment induced bone loss has been retrospectively studied as a distinct entity in gynaecological cancers. Amongst gynaecological cancers, cervical cancer is the leading cause of mortality and morbidity, majorly in developing countries. Concurrent chemoradiation (CCRT) is considered as the standard of care in managing these patients. Persistent low back ache is often reported as a potential post treatment sequalae by long term survivors of cervical malignancy. Various retrospective studies done have observed reduced density and osteopenia of the bones in the irradiated area, as a possible etiologic factor for persistent low back ache.Methods:We in this prospective clinical trial propose to prospectively and systematically evaluate the changes in pelvic bone density in patients of cervical cancer receiving chemoradiotherapy using dual energy X-ray absorptiometry (DEXA) scan done pre and post treatment, and correlate the changes with occurrence and severity of persistent low back ache.Low back ache will be evaluated using Oswestry low back pain disability scale, scoring for which shall be done pre-treatment and then at post treatment at 2 monthly interval for 1 year on follow up. Conclusions: Results from the trial might bring-forth the changes in the density of pelvic bones in patients of cancer cervix undergoing concurrent chemoradiation and its correlation with low back ache, if any.Trial Registration: This trial is registered with number CTRI/2017/05/008606.

Dose-volume restriction analysis based on ≥grade Ⅱ marrow suppression in radiotherapy for pelvic cancer / 中华放射肿瘤学杂志

Objective@#To investigate the correlation between bone marrow suppression and the dose volume analysis of pelvic bone and provide reference for defining the parameters of bone volume-dose restriction during pelvic radiotherapy.@*Methods@#A retrospective analysis of 102 cases of cervical cancer, 53 cases of rectal cancer and 34 cases of prostate cancer in People′s Hospital of Xinjiang Uygur Autonomous Region from January 2013 to April 2016 was performed. All patients received pelvic irradiation at a dose of 50.0-50.4Gy, and a boost of 10-24 Gy was given for different types of tumors or tumor beds. Concurrent chemotherapy was carried out in patients with cervical cancer and colorectal cancer, and endocrine therapy was given to prostate cancer patients during radiotherapy. The parameters including the target bone volume, V10, V20, V30, V40, V50, and the grade of bone marrow suppression according to RTOG grading scale within 3 months after radiotherapy or 6 months post-radiotherapy were evaluated. The correlation between the irradiation bone volume and the grade of bone marrow suppression was assessed by univariate analysis. The relationship between the grade of bone marrow suppression and age, chemotherapy and radiotherapy dose was further analyzed by multivariate analysis.@*Results@#In patients with cervical, rectal and prostate cancer, the overall incidence rate of early bone marrow suppression was 77.5%, 79.2% and 70.6%, and 65.7%, 62.3% and 35.3% for ≥grade 2 bone marrow suppression, respectively. Late-stage bone marrow suppression occurred in 11 patients, grade Ⅱ in 7 cases, and the incidence rate of ≥grade 2 bone marrow suppression was 3.7%. The target bone volume in the cervical, rectal and prostate cancer groups was (746.30±27.84) cm3, (736.15±28.72) cm3 and (740.70±35.08) cm3(P=0.023), respectively. Univariate and multivariate analyses revealed that V10, V20, V30, V40 and CV10, CV20, CV30, CV40 were not significantly correlated with the grading of bone marrow suppression (all P>0.05), whereas V50 and CV50 were significantly correlated with bone marrow suppression (both P<0.05). ROC curve analysis demonstrated that V50=72.33 cm3 and CV50=9.42% were the diagnostic cut-off values for ≥grade 2 bone marrow suppression.@*Conclusions@#The incidence of bone marrow suppression is relatively high in pelvic radiotherapy, which is correlated with the irradiation bone volume and dose in the target area. At a total dose of 50 Gy, the incidence of ≥grade 2 bone marrow suppression is not associated with ≤V40 or absolute volume. Besides, it is not correlated with dose boost or whether chemotherapy is delivered, whereas it is associated with V50 and absolute volume. V50=10.23% and CV50=72.33 cm3 are the cut-off values for the incidence of ≥grade 2 bone marrow suppression.

Research progress in effect of pelvic bone marrow-sparing intensity-modulated radiotherapy on hematologic toxicity in pelvic tumor patients after concurrent chemoradiotherapy / 中华放射肿瘤学杂志

Concurrent chemoradiotherapy can improve the survival rate in patients with advanced pelvic tumors.However,it also increases the incidence of hematologic toxicity and other adverse events.Patients cannot tolerate these adverse events and discontinue the therapy.Pelvic bone marrow-sparing intensity-modulated radiotherapy (PBMS-IMRT) possesses obvious advantages in reducing the radiation dose and volume of the pelvic bone marrow.In this article,comparison between PBMS-IMRT and other irradiation therapies,correlation between dosimetric parameters and hematologic toxicity and imaging methods with precise delineation of the active bone marrow were reviewed.

Análisis descriptivo de la asimetría pélvica en una población asintomática / Descriptive analysis of pelvic asymmetry in an asymptomatic population

Introducción: La inclinación pélvica es evaluada clínicamente por su relación con patologías espinales. Pero hay pocas evidencias sobre la población asintomática para comparaciones. Objetivo: Analizar una población asintomática según las asimetrías pélvicas por fotogrametría. Material y métodos: 92 sujetos (18-35 años) fueron marcados en las espinas ilíacas anteriores y posteriores y fotografiados. El software Alcimage midió el ángulo de báscula pélvica. La normalidad probada por Kolmogorov; la prueba t y Wilcoxon para comprobar diferencias, la correlación medida por el coeficiente Pearson. Resultados: De los varones, 11.96% presentaran anteversión y 34.78% normalidad. De las mujeres, 38.04% anteversión y 15.22% normalidad. Los ángulos entre ilíacos para báscula bilateral no presentaron diferencia, pero hubo diferencia con predominancia de lado. Para báscula unilateral hubo diferencia entre ilíacos. Hubo buena correlación de predominancia versus anteversión y pobre para los ángulos de perfil. Los demás, débiles o sin significancia. Conclusión: La báscula no puede ser usada individualmente para caracterización de disfunción o patología pélvica.

Introduction: Pelvic tilt is clinically assessed based on its relationship with spinal conditions, but there is little evidence from the asymptomatic population for comparison purposes. Objective: To analyze an asymptomatic population focusing on pelvic asymmetries using photogrammetry. Material and methods: 92 subjects (18-35 years old) underwent marking of the anterior and posterior iliac spines and were photographed. Alcimage software was used to measure the pelvic tilt angle. Other tests included: the Kolmogorov normality test, t test, Wilcoxon test, and Pearson coefficient to measure the correlation. Results: 11.96% of males had anteversion and 34.78% normality; 38.04% of females had anteversion and 15.22% normality. Angles between iliacs for bilateral tilt showed no difference, but a difference was seen with the predominance of one side. For unilateral tilt a difference between iliacs was seen. Good correlation of predominance versus anteversion was observed, and correlation was poor for side angles. The rest showed a weak or non-significant correlation. Conclusion: Tilt cannot be used individually to characterize pelvic dysfunction or pathology.

Pelvic Bone Fracture with Bladder Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture. MATERIALS AND METHODS: From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively. RESULTS: There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture. CONCLUSION: Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

Analysis for Usefulness of Arterial Embolization on Sacral and Pelvic Giant Cell Tumors / 대한골관절종양학회지

PURPOSE: The purpose of this study is to determine the usefulness of arterial embolization on sacral and pelvic giant cell tumor (GCT). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 9 patients who had undergone serial arterial embolization between December 1996 and May 2008. We analyzed the clinical outcomes and therapeutic responsiveness of arterial embolization on sacral and pelvic GCT. RESULTS: Six of 9 cases showed progression of disease (PD) status, even if 5 cases showed PD status despite of additional treatments including surgery and radiation, implying that serial arterial embolization on sacral and pelvic GCT is not effective. Three of 9 cases showed stable disease (SD) or continuous disease free (CDF) status and we analyzed associated factors with these good responses for embolization by chi2 test. The number of feeding vessels under six (p=0.048) and the number of collateral arterial supply under three (p=0.048) in the first angiogram showed significant relationships with good response for embolization, while remaining tumor staining by contrast after the first embolization and repeated embolization times were not significant. CONCLUSION: Although serial arterial embolization is not an effective modality on sacral and pelvic giant cell tumors, it may be a pilot modality under narrow indication of tumors with poor vascularity at first angiogram.

A case of isolated metastatic hepatocellular carcinoma arising from the pelvic bone / 대한간학회지

Reports of metastatic hepatocellular carcinoma (HCC) without a primary liver tumor are rare. Here we present a case of isolated HCC that had metastasized to the pelvic bone without a primary focus. A 73-year-old man presented with severe back and right-leg pain. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed a huge mass on the pelvic bone (13x10 cm). He underwent an incisional biopsy, and the results of the subsequent histological examination were consistent with metastatic hepatocellular carcinoma. The tumor cells were positive for cytokeratin (AE1/AE3), hepatocyte paraffin 1, and glypican-3, and negative for CD56, chromogranin A, and synaptophysin on immunohistochemical staining. Examination of the liver by CT, MRI, positron-emission tomography scan, and angiography produced no evidence of a primary tumor. Radiotherapy and transarterial chemoembolization were performed on the pelvic bone, followed by systemic chemotherapy. These combination treatments resulted in tumor regression with necrotic changes. However, multiple lung metastases developed 1 year after the treatment, and the patient was treated with additional systemic chemotherapy.

Pelvic aneurysmal bone cyst

This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient’s 5th decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.

Cystic Echinococcosis of the Pelvic Bone with Recurrences: A Case Report

Hydatid cysts commonly affect the liver and the lung. However, they rarely involve bones with vertebral column. We hereby report a case of a female patient with cystic echinococcosis of the hip bone and ilium. She presented with a long history of frequent recurrences highlighting the dismal prognosis at this rare site. Resection of the hydatid cyst from the sacroiliac region was done with allograft and autograft (rib graft) with lumbosacroiliac fixation. Follow-up of the patient at 6 months showed no detectable abnormality on radiology and the patient was doing well.

A Clinical Review of Geriatric Patients with Pelvic Bone Fractures

BACKGROUND: The purpose of this study was to compare clinical aspects of pelvic fractures in an aged group with a non-aged group and to delineate its characteristics to improve prevention and treatment. METHODS: Medical records and radiological examinations of 100 cases were reviewed. Two groups were created, older than 65 years and younger than 65 years. In addition, the following were carefully examined and recorded-gender distribution, cause and types of fractures, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale, need for intensive care unit admission, duration of hospitalization, and mortality rate. RESULTS: A difference in gender distribution was seen with 12 males and 26 females in the aged group and 35 males and 27 females in the non-aged group (p<0.05). The mechanism of injury for the aged group in decreasing order was pedstrian accidents, falls, and passenger accidents while it was passenger accidents, pedestrian accidents, and falls for the non-aged group (p<0.05). Level of severity was higher in the non-aged group for fracture type, ISS, Glasgow Coma Scale, intensive care unit admission, and hospitalization duration. However, when ISS was greater than 15, this was seen in the aged group with also a higher mortality rate in the same group. CONCLUSION: Education and prevention, particularly about gender distribution and mechanism of injury, of pelvic fractures in the aged population are needed, and because of the potential seriousness of fractures in the elderly, active assessment and treatment are also necessary.

Pelvic Ring Injury

The function of the pelvic bone is to transmit the body weight to the lower extremities and protect the internal organs in the abdomen and pelvic cavity. Most pelvic fractures occur from high energy trauma, and injuries associated with other parts of the body are common. The characteristics of pelvic fractures may have a significant effect on the patient's general condition and prognosis after treatment. Therefore, the patient's general condition should be considered before treating pelvic fractures to decrease the complications and mortality. After the patient's vital signs are stabilized, simple X-rays and CT should be examined to evaluate the fracture pattern and possible injury mechanism. A high energy induced pelvic ring injury should be treated by experienced surgeons and the biomechanics should be understood completely beforehand to achieve the best possible result.

Osteonecrosis of Femoral Head after Pelvic Fracture: A Case Report / 대한정형외과학회잡지

We report on a case of osteonecrosis of the femoral head after a traumatic pelvic injury, and this was not associated with skeletal injuries to his hip joint. An adolescent male developed ostenecrosis of the femoral head following a pelvic fracture, but his hip joint was not injured by the pelvic fracture. To the best of our knowledge, such a finding has not been previously reported. The risk factors fot osteonecrosis are also reviewed.

The Need for an Additional Pelvic CT in Cases of Acute Osseous Pelvic Injury that Has Already Been Diagnosed by Abdominal CT

PURPOSE: Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries. METHODS: A retrospective investigation of patients' electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT. RESULTS: Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type. CONCLUSION: This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction.

Clinical Profiles of Patients who Undergone Emergency Angiographic Embolization at Emergency Department

PURPOSE: Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation. METHODS: We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors. RESULTS: Representative values were compared between survivors and non-survivors : RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes. CONCLUSION: The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage.

Effectiveness of Arterial Embolization in Hemodynamically Unstable Pelvic Fracture

Purpose: To assess the effectiveness and appropriate time for arterial embolization with angiography in patients who sustained a hemodynamically unstable pelvic bone fracture Materials and methods: Nineteen cases with hemodynamically unstable pelvic bone fractures that were managed with arterial embolization out of 287 pelvic bone fractures between May, 2002 and February, 2007 were reviewed retrospectively. The blood pressure, pulse rate, hemoglobin, prothrombin time, partial prothrombin time and platelet checked were evaluated immediately after arrival at the emergency room, before and after embolization. Repeated measures analysis of variance was used for the statistical evaluation. Results: The blood pressure showed a statistically significant increase from before and after embolization. The hemoglobin and prothrombin time checked upon arrival were significantly lower than those checked before embolization. In addition, the hemoglobin and prothrombin time was significantly higher before embolization than after embolization. The partial thromboplastin time and platelet checked immediately upon arrival were significantly lower than those checked before embolization. Conclusion: Interventional angiography and embolization can be an effective treatment modality in patients with hemodynamically unstable pelvic bone fractures showing rapid changes in the hemoglobin level, prothrombin time, partial thromboplastin time and platelet count but little response to fluid and transfusion resuscitation,.

Noninvasive Reduction of Fractures of Pubis and Separation of Symphysis Pubis by Circumferential Pelvic Belt: A case report

Early reduction and stabilization of the pelvic bone after traumatic unstable pelvic bone fracture is the most effective method to control life-threatening bleeding and reduce late complication. In this study, we compared the effect of the non-invasive pelvic belt on various positions, and studied the effects of weight bearing and shifting during walking on pelvic belt position. Case 1) separation of symphysis pubis; Case 2) fracture of the superior and inferior ramus of the right pubis; Case 3) fractures of the superior and inferior ramus of both pubis and separation of symphysis pubis. Pelvic belt was prescribed in all three cases. Pelvic belt reduction reduced the distance between fracture line by 40~60% at all levels. Therefore, pelvic belt reduction is recommended as a non-invasive, safe and effective rehabilitative treatment for pelvic bone fracture patients to restore function without pain or secondary injury.

Factors Affecting Hemodynamic Instability in Patients with Pelvic Bone Fracture

PURPOSE: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. METHODS: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. RESULTS: The mean age of the patients was 48.8+/-18.7, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was 7.5+/-8.7 days in intensive care and 55.1+/-47.9 days in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). CONCLUSION: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.

Comparison of Survival in Pelvic Bone Fractures with Arterial Embolization

PURPOSE: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. METHODS: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. RESULTS: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (+/-0.20) vs 7.30 (+/-0.08), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group (24.1+/-12.5 vs 14.4+/-6.8, p=0.046). CONCLUSION: No differences in initial blood pressure and trauma scores existed between survivors and nonsurvivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

Comparisons of Fracture Types and Pelvic Angiographic Findings in Hemodynamically Unstable Pelvic Bone Fracture

PURPOSE: Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings. METHODS: We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile's classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings. RESULTS: In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: +/-20.1). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery. CONCLUSION: The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings.