Pelvic Fracture Classification

TLDR

Hemorrhage remains the leading cause of death in patients with pelvic fractures. The study aims to identify patients at greatest risk for massive hemorrhage. The authors retrospectively reviewed charts and initial ER AP radiographs of 245 patients, classifying fractures using a modified Pennel and Sutherland scheme to develop a simple classification. The classification predicts that 50–69% of unstable fractures need 4+ units of blood, 30–49% need >10 units, 36–55% have intraabdominal injury, and 6–18% have pelvic arterial injury, enabling a 90% confident identification of patients at high risk for massive hemorrhage.

Abstract

Hemorrhage remains the leading cause of death in patients with pelvic fractures. To identify patients at greatest risk for massive hemorrhage, we retrospectively reviewed charts and initial emergency room anterior-posterior (AP) radiographs of 245 consecutive patients. Pelvic fractures were classified according to our modification of the Pennel and Sutherland classification scheme. A simple pelvic fracture classification scheme was developed. Using this classification, we can be 90% confident that 50 to 69% of patients with “unstable” pelvic fractures will require 4 or more units of blood, 30 to 49% will require greater than 10 units of blood, 36 to 55% will have an intraabdominal injury, and 6 to 18% will have a pelvic arterial injury. Therefore we conclude that this pelvic fracture classification based on the initial emergency-room AP X-ray can predict a patient population at high risk for massive hemorrhage for which an aggressive treatment protocol is justified.