Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2024; 15(5): 418-434
Published online May 18, 2024. doi: 10.5312/wjo.v15.i5.418
Pelvic fractures in blunt trauma patients: A comparative study
Alexander A Fokin, Joanna Wycech Knight, Madison E Tharp, Kyler C Brinton, Phoebe K Gallagher, Justin Fengyuan Xie, Russell D Weisz, Ivan Puente
Alexander A Fokin, Joanna Wycech Knight, Madison E Tharp, Kyler C Brinton, Phoebe K Gallagher, Justin Fengyuan Xie, Russell D Weisz, Ivan Puente, Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
Alexander A Fokin, Ivan Puente, Charles E Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, FL 33431, United States
Joanna Wycech Knight, Ivan Puente, Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
Madison E Tharp, Kyler C Brinton, Phoebe K Gallagher, Justin Fengyuan Xie, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
Ivan Puente, Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, Miami, FL 33199, United States
Author contributions: Fokin AA and Puente I conceptualized the research study; Fokin AA, Wycech Knight J, Weisz RD, and Puente I designed the methodology; Fokin AA and Puente I were the project administrators and supervisors; Wycech Knight J, Tharp M, Brinton K, Gallagher PK, and Xie JF performed the research; Wycech Knight J performed the software analysis; Fokin AA, Wycech Knight J, Tharp M, Brinton K, Gallagher PK, Xie JF, Weisz RD, and Puente I performed formal data analysis and validation; Fokin AA, Wycech Knight J, and Puente I wrote the original draft of the manuscript; Fokin AA, Wycech Knight J, Tharp M, Brinton K, Gallagher PK, Xie JF, Weisz RD, and Puente I performed manuscript review and editing; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by the MetroWest Institutional Review Board.
Informed consent statement: This study was granted a waiver for informed consent by the MetroWest Institutional Review Board.
Conflict-of-interest statement: Alexander A Fokin, Joanna Wycech Knight, Madison Tharp, Kyler Brinton, Phoebe K Gallagher, Justin F Xie, Russell D Weisz and Ivan Puente declare that they have no conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Data sharing statement: Deidentified data and study materials are available upon reasonable request from the corresponding author at alexander.fokin@tenethealth.com.
STROBE statement: The authors have read the STROBE statement – checklist of items, and the manuscript was prepared and revised according to the STROBE statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexander A Fokin, MD, PhD, Professor, Instructor, Researcher, Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, United States. alexander.fokin@tenethealth.com
Received: December 18, 2023
Revised: April 9, 2024
Accepted: April 23, 2024
Published online: May 18, 2024
Abstract
BACKGROUND

Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones. Presence of contrast blush (CB) on computed tomography in patients with PF is considered a sign of active bleeding, however, its clinical significance and association with outcomes is debatable.

AIM

To analyze polytrauma patients with PF with a focus on the geriatric population, co-injuries and the value of contrast blush.

METHODS

This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center (01/2017-01/2023). Analyzed variables included: Age, sex, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), abbreviated injury scale (AIS), co-injuries, transfusion requirements, pelvic angiography, embolization, laparotomy, orthopedic pelvic surgery, intensive care unit and hospital lengths of stay, discharge disposition and mortality. The study compared geriatric and non-geriatric patients, patients with and without CB and abdominal co-injuries. Propensity score matching was implemented in comparison groups.

RESULTS

PF comprised 4% of all trauma admissions. 89 patients had CB. 286 (52%) patients had concomitant injuries including 93 (17%) patients with abdominal co-injuries. Geriatric patients compared to non-geriatric had more falls as MOI, lower ISS and AIS pelvis, higher GCS, less abdominal co-injuries, similar CB and angio-embolization rates, less orthopedic pelvic surgeries, shorter lengths of stay and higher mortality. After propensity matching, orthopedic pelvic surgery rates remained lower (8% vs 19%, P < 0.001), hospital length of stay shorter, and mortality higher (13% vs 4%, P < 0.001) in geriatric patients. Out of 89 patients with CB, 45 (51%) were embolized. After propensity matching, patients with CB compared to without CB had more pelvic angiography (71% vs 12%, P < 0.001), higher embolization rates (64% vs 22%, P = 0.02) and comparable mortality.

CONCLUSION

Half of the patients with PF had concomitant co-injuries, including abdominal co-injuries in 17%. Similarly injured geriatric patients had higher mortality. Half of the patients with CB required an embolization.

Keywords: Pelvic fractures, Geriatric trauma patients, Abdominal co-injuries, Contrast blush, Contrast extravasation, Angioembolization, Polytrauma patients, Surgical interventions, Blunt trauma, External and internal fixation for pelvic stabilization

Core Tip: We analyzed 558 patients with pelvic fractures after blunt trauma admitted to an urban level 1 trauma center over a 6-year period. To ensure similar injury severity, propensity score matching methodology was implemented to compare geriatric and non-geriatric patients, and to assess the impact of abdominal co-injuries and clinical value of contract blush. It was established that half of the patients with pelvic fractures had concomitant injuries and that similarly injured geriatric patients had significantly higher mortality than non-geriatric patients. Abdominal co-injuries were diagnosed in 17% of patients. Contrast blush was present in one fifth of patients with PF but only half of them required embolization and in similarly injured subjects there was no association with longer hospitalization or higher mortality.