Prevalence of pelvic CT angiography (CTA) and angiographic embolization in geriatric patients with pelvic ring fractures presenting to two level I trauma centers

• Published in: Injury 2024-11, Vol.55 (11), p.111767, Article 111767
• Main Authors: McDonald, John C., Kent, Suzanne, LeRoy, Taryn, Peat, Aidan, Hedeman, Margaret, McGrath, Cole, Sharma, Arnav, Marcantonio, Andrew J., Ryan, Scott P.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Computed Tomography Angiography; Embolization, Therapeutic - methods; Female; Fractures, Bone - diagnostic imaging; Fractures, Bone - therapy; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - therapy; Hospital Mortality; Humans; Male; Osteoporotic Fractures - diagnostic imaging; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - therapy; Pelvic arterial embolization; Pelvic Bones - diagnostic imaging; Pelvic Bones - injuries; Pelvic CTA; Pelvic ring injury; Prevalence; Retrospective Studies; Trauma Centers; Young-burgess classification
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111767

Hemorrhage in osteoporotic pelvic ring fractures is a rare, but serious complication. Most bleeding comes from the bone or venous plexuses, but arterial injury does occur. The purpose of this study was to characterize a large geriatric pelvic fracture cohort and determine the prevalence of pelvic CT angiography (CTA) and subsequent need for arterial embolization. A cohort of geriatric pelvic fracture patients at two level 1 trauma centers was reviewed. Many epidemiologic and patient factors were collected for cohort characterization. The primary outcome was if patients underwent a CTA of the pelvis and subsequently underwent arterial embolization. There were 457 patients included and mean age was 83.1 years (range 65–100). Most patients had a low energy mechanism (91.4 %). In-hospital mortality was recorded for 30 cases (6.6 %). Of these deaths, two received a pelvic CTA and two had an embolization procedure. Pelvic CTA was performed on 33 patients (7.2 %). Fourteen patients (3.0 %) had an arterial embolization procedure. A high energy mechanism of injury was associated with receiving a pelvic CTA (p = 0.0067). Mechanism of injury was not associated with undergoing an embolization procedure (p = 0.685). In the geriatric population, even patients with stable pelvic fractures can present with life-threatening arterial bleeding. A non-insignificant percentage of patients will require CTA for suspected bleeding (7.2 %) and embolization to treat confirmed arterial bleeding (3.0 %). Bleeding events in geriatric pelvic ring injuries is a previously under researched area of orthopedic trauma. Further research is needed to elucidate the exact pathomechanisms of arterial injury and what patients or injury patterns are most significantly associated. Specifically, larger cohort sizes and evaluating our existing cohort with different injury classification systems may yield useful results.