Intraoperative Angioembolization in the Management of Pelvic Fracture-Related Hemodynamic Instability
Condition: Pelvic Fractures and Associated Hemodynamic Instability
MeSH terms: Fractures, Bone; Hip Fractures
Study type: Observational

Summary: 
      Mortality associated with pelvic fractures resulting from blunt trauma ranges between 6 and
      18%. In cases where hemodynamic instability is also present, the mortality rate is
      significantly greater, and has been reported as high as 60%. There is no general consensus
      among traumatologists as to the initial management of this complicated subgroup of patients.
      It is largely debated whether emergent orthopedic fixation or angiographic embolization
      should be the first line of treatment for pelvic hemorrhage
    

Detailed description: 
      Pelvic fractures are not usually isolated injuries and it is common that these severely
      injured patients have concomitant abdominal or thoracic trauma further complicating their
      management. In situations where multiple sources of hemodynamic instability exist, the need
      to control hemorrhage quickly becomes imperative. In patients where emergent laparotomy or
      thoracotomy is indicated, the time until pelvic bleeding sources are addressed is prolonged.
      Some would argue that the best initial management of the pelvic fractures should be surgical
      stabilization, while others would support immediate angioembolization of actively bleeding
      pelvic vessels. The main drawback of angiographic embolization is that it occurs in a
      separate Angio Suite facility, with concerns being time lost to patient transport and an
      environment less capable of managing these extremely unstable patients.

      At Hershey Medical Center, ten patients suffering pelvic fractures with associated
      hemodynamic instability between 2003 and 2007 were managed with intraoperative
      angioembolization (in the Operating Room as opposed to the Angio Suite). Extensive review of
      published orthopaedic, trauma surgery, and radiology journals yielded no other literature
      regarding intraoperative angioembolization as a management approach for these patients.
      Whether or not this approach has been carried out at other medical institutions, it is
      undoubtedly rare and results have yet to be reported in widely available literature. This
      novel approach has the potential to stop pelvic bleeding sooner and in a more controlled
      environment, where surgical stabilization can also be accomplished simultaneously.
      Statistical analysis and review of these patients has not been done, but may possibly show
      improvements in survival, shorter length of hospital stay, less time to embolization, and
      decreased need for supportive measures such as blood or platelet transfusion.
    

Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        The subjects in this study are trauma patients over 18 years of age who suffered pelvic
        fractures and developed associated hemodynamic instability between January 1, 2003 and
        December 31, 2007. All patients were treated at Hershey Medical Center and received
        intraoperative angioembolization as a part of their medical management.
      
Keywords: pelvic fractures; angioembolism; Treatment at Hershey Medical Center; Angioembolization in Operating Room