Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study
Abstract Background The aim of this study was to determine the rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries (PRI). Methods This retrospective cohort study was conducted in a level I trauma center serving 500,000 inhabitants. A total of 1...
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-021-00470-y |
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| author | Anna-Eliane Abboud Sana Boudabbous Elisabeth Andereggen Michaël de Foy Alexandre Ansorge Axel Gamulin |
| author_facet | Anna-Eliane Abboud Sana Boudabbous Elisabeth Andereggen Michaël de Foy Alexandre Ansorge Axel Gamulin |
| author_sort | Anna-Eliane Abboud |
| collection | DOAJ |
| description | Abstract Background The aim of this study was to determine the rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries (PRI). Methods This retrospective cohort study was conducted in a level I trauma center serving 500,000 inhabitants. A total of 127 consecutive patients with high-energy blunt PRI were included between January 1st, 2014 and December 31st, 2017. Every patient had a total body or thoraco-abdominal computed tomography scan including contrast enhanced arterial sequences. A board-certified radiologist reviewed all the vascular images and precisely described every intra-pelvic arterial lesion in terms of localization. Complete pelvic series (standard radiographs and fine cut computed tomography images) were reviewed by three board-certified orthopedic surgeons experienced in PRI management, and Young and Burgess and AO/OTA classifications were determined. Demographic, clinical, therapeutic and outcome data were extracted from the institutional severely injured patients’ registry. Results Patients’ mean age was 45.3 years and 58.3% were males. Fifteen (11.8%) had a total of 21 intra-pelvic arterial lesions: seven lesions of the obturator artery, four of the superior gluteal artery, three of the inferior gluteal artery, two of the vesical artery, and one of each of the following arteries: internal iliac, internal pudendal, fifth lumbar, lateral sacral, ilio-lumbar. These lesions occurred in 8.6% of lateral compression injuries, 33.3% of anteroposterior compression injuries and 23.5% of vertical shear and combined mechanism injuries (Young and Burgess classification, p = 0.003); and in 0% of type A injuries, 9.9% of type B injuries and 35% of type C injuries (AO/OTA classification, p = 0.001). Patients with an intra-pelvic arterial lesion were more likely to present with pre-hospital hemodynamic instability (p = 0.046) and to need packed red blood cells transfusion within the first 24 h (p = 0.023; they needed a mean of 7.53 units vs. 1.88, p = 0.0016); however, they did not have a worst outcome in terms of complications or mortality. Conclusions This systematic study found an 11.8% rate of intra-pelvic arterial lesion related to high-energy blunt PRI. The obturator, superior gluteal and inferior gluteal arteries were most often injured. These findings are important for the aggressive management of high-energy blunt PRI. |
| first_indexed | 2024-12-22T13:02:50Z |
| format | Article |
| id | doaj.art-cd31a13b42864046848436d8aaf5e4cf |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-22T13:02:50Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-cd31a13b42864046848436d8aaf5e4cf2022-12-21T18:24:57ZengBMCBMC Emergency Medicine1471-227X2021-06-0121111010.1186/s12873-021-00470-yIncidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort studyAnna-Eliane Abboud0Sana Boudabbous1Elisabeth Andereggen2Michaël de Foy3Alexandre Ansorge4Axel Gamulin5Division of Orthopaedic and Trauma Surgery, University Hospitals of GenevaDepartment of Radiology, University Hospitals of GenevaDivision of Emergency Medicine, University Hospitals of GenevaDivision of Orthopaedic and Trauma Surgery, University Hospitals of GenevaDivision of Orthopaedic and Trauma Surgery, University Hospitals of GenevaDivision of Orthopaedic and Trauma Surgery, University Hospitals of GenevaAbstract Background The aim of this study was to determine the rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries (PRI). Methods This retrospective cohort study was conducted in a level I trauma center serving 500,000 inhabitants. A total of 127 consecutive patients with high-energy blunt PRI were included between January 1st, 2014 and December 31st, 2017. Every patient had a total body or thoraco-abdominal computed tomography scan including contrast enhanced arterial sequences. A board-certified radiologist reviewed all the vascular images and precisely described every intra-pelvic arterial lesion in terms of localization. Complete pelvic series (standard radiographs and fine cut computed tomography images) were reviewed by three board-certified orthopedic surgeons experienced in PRI management, and Young and Burgess and AO/OTA classifications were determined. Demographic, clinical, therapeutic and outcome data were extracted from the institutional severely injured patients’ registry. Results Patients’ mean age was 45.3 years and 58.3% were males. Fifteen (11.8%) had a total of 21 intra-pelvic arterial lesions: seven lesions of the obturator artery, four of the superior gluteal artery, three of the inferior gluteal artery, two of the vesical artery, and one of each of the following arteries: internal iliac, internal pudendal, fifth lumbar, lateral sacral, ilio-lumbar. These lesions occurred in 8.6% of lateral compression injuries, 33.3% of anteroposterior compression injuries and 23.5% of vertical shear and combined mechanism injuries (Young and Burgess classification, p = 0.003); and in 0% of type A injuries, 9.9% of type B injuries and 35% of type C injuries (AO/OTA classification, p = 0.001). Patients with an intra-pelvic arterial lesion were more likely to present with pre-hospital hemodynamic instability (p = 0.046) and to need packed red blood cells transfusion within the first 24 h (p = 0.023; they needed a mean of 7.53 units vs. 1.88, p = 0.0016); however, they did not have a worst outcome in terms of complications or mortality. Conclusions This systematic study found an 11.8% rate of intra-pelvic arterial lesion related to high-energy blunt PRI. The obturator, superior gluteal and inferior gluteal arteries were most often injured. These findings are important for the aggressive management of high-energy blunt PRI.https://doi.org/10.1186/s12873-021-00470-yHigh-energy pelvic ring injuryHigh-energy blunt traumaIntra-pelvic arterial lesionIncidenceTopography |
| spellingShingle | Anna-Eliane Abboud Sana Boudabbous Elisabeth Andereggen Michaël de Foy Alexandre Ansorge Axel Gamulin Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study BMC Emergency Medicine High-energy pelvic ring injury High-energy blunt trauma Intra-pelvic arterial lesion Incidence Topography |
| title | Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study |
| title_full | Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study |
| title_fullStr | Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study |
| title_full_unstemmed | Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study |
| title_short | Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study |
| title_sort | incidence rate and topography of intra pelvic arterial lesions associated with high energy blunt pelvic ring injuries a retrospective cohort study |
| topic | High-energy pelvic ring injury High-energy blunt trauma Intra-pelvic arterial lesion Incidence Topography |
| url | https://doi.org/10.1186/s12873-021-00470-y |
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