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      Earthquake-related pelvic crush fracture vs. non-earthquake fracture on digital radiography and MDCT: a comparative study

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          Abstract

          OBJECTIVE:

          To determine the features of earthquake-related pelvic crush fractures versus non-earthquake fractures with digital radiography and multidetector row computed tomography.

          METHODS:

          One hundred and sixty-seven survivors with pelvic crush fractures in the 2008 Sichuan earthquake were entered in our study as the earthquake-related group (139 underwent digital radiography, 28 underwent multidetector row computed tomography); 70 victims with non-earthquake pelvic fractures were enrolled into this study as the non-earthquake group (54 underwent digital radiography, 16 underwent multidetector row computed tomography). Data were reviewed retrospectively between groups, focusing on anatomic distributions, status of pelvic bone fractures, numbers of pelvic bones involved, and classification of pelvic ring fractures according to the Tile classification system.

          RESULTS:

          Pelvic fractures occurred more frequently in the pubis in the earthquake-related group than in the non-earthquake group (135/167, 81% vs. 48/70, 69%). In addition, comminuted fractures were more common in the earthquake-related group than in the non-earthquake group (55/167, 33% vs. 10/70, 14%). Multiple fractures were less common in the earthquake-related group than in the non-earthquake group (81/167, 49% vs. 46/70, 66%). Regarding the classification of pelvic ring fractures, Type C predominantly composed of subtype C3 occurred more frequently (64/167, 38% vs. 12/70, 17%), and Type A was less common in the earthquake-related group than in the non-earthquake group (31/167, 19% vs. 23/70, 32%). All differences were statistically significant (p<0.05). No difference was found in Type B fractures between the groups (72/167, 43% vs. 35/70, 50%).

          CONCLUSION:

          Earthquake-related pelvic crush fractures can be characterized by a high incidence of pelvic fractures occurring in the pubis, comminuted fractures, and Type C fractures predominantly composed by subtype C3, despite a low incidence of multiple fractures.

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          Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome.

          R Brumback, Steven J. Siegel, Nazma A. Burgess … (1989)
          Three hundred forty-three multiple trauma patients with major pelvic ring disruption were studied and subdivided into four major groups by mechanism of injury: antero-posterior compression (APC), lateral compression (LC), vertical shear (VS), and combined mechanical injury (CMI). Acetabular fractures which did not disrupt the pelvic ring were excluded. The mode of injury was: MVA, 57.4%; motorcycle, 9.3%; fall, 9.3%; pedestrian, 17.8%; crush, 3.8%. The LC and APC groups were divided into Grades 1-3 of increasing severity. The pattern of organ injury: including brain, lung, liver, spleen, bowel, bladder, pelvic vascular injury (PVASI), retroperitoneal hematoma (RPH) and complications: circulatory shock, sepsis, ARDS, abnormal physiology, and 24-hr total fluid volume administration were all evaluated as a function of mortality (M). As LC grade increased from 1 to 3 there was increased % incidence of PVASI, RPH, shock, and 24-hr volume needs. However, the large incidence of brain, lung, and upper abdominal visceral injuries as causes of death in Grade 1 and 2 fell in LC3, with limitation of the LC3 injury pattern to the pelvis. As APC grade increased from 1 to 3 there was increased % injury to spleen, liver, bowel, PVASI with RPH, shock, sepsis, and ARDS, and large increases in volume needs, with important incidence of brain and lung injuries in all grades. Organ injury patterns and % M associated with vertical shear were similar to those with severe grades of APC, but CMI had an associated organ injury pattern similar to lower grades of APC and LC fractures. The pattern of injury in APC3 was correlated with the greatest 24-hour fluid requirements and with a rise in mortality as the APC grade rose. However, there were major differences in the causes of death in LC vs. APC injuries, with brain injury compounded by shock being significant contributors in LC. In contrast, in APC there were significant influences of shock, sepsis, and ARDS related to the massive torso forces delivered in APC, with large volume losses from visceral organs and pelvis of greater influence in APC, but brain injury was not a significant cause of death. These data indicate that the mechanical force type and severity of the pelvic fracture are the keys to the expected organ injury pattern, resuscitation needs, and mortality.
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            Fatal and hospitalized injuries resulting from the 1994 Northridge earthquake.

            Stephane L. Bourque, D Vimalachandra, J. K. Kraus … (1998)
            The Northridge earthquake struck Los Angeles on 17 January 1994, originating from a previously unknown thrust fault. The earthquake measured 6.7 on the Richter scale and caused extensive damage to buildings, utilities and roadways. This report describes injuries occurring in the Northridge earthquake which resulted in death or hospital admission. Earthquake-related deaths were identified by the Los Angeles Department of the Coroner. All 78 hospitals in Los Angeles County were screened for earthquake-related admissions and were found in 16 of them. Coroner's records and medical records from the 16 hospitals were individually reviewed to identify earthquake-related injuries and to obtain information about the injury. A total of 171 earthquake-related injuries was identified in Los Angeles County, 33 were fatal and 138 required hospital admission. Injury rates were approximately equal by gender and increased significantly with increasing age. Most of the fatalities were due to building collapse, and most of the hospital-admitted injuries were caused by falls or being hit by objects. Motor vehicle injuries and burns were also common causes of injury. Head and chest injuries were common among fatalities, and extremity injuries were the most common among those admitted to a hospital. Earthquakes cause injuries through many mechanisms, and a clearer understanding of these pathways can help focus prevention strategies. Research combining comprehensive surveillance with risk factor assessment can help identify behaviours and circumstances increasing the risk of injury in an earthquake.
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              The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures.

              Jose Gustavo Parreira, Raul Coimbra, Samir Rasslan … (2000)
              In order to identify the prognostic factors and to evaluate the impact of associated injuries in the outcome of patients with pelvic fractures, a retrospective review of the medical records of patients admitted with a pelvic fracture during a 42-month period was carried out. Demographic data, the mechanism of injury, the physiologic status on admission, associated injuries, pelvic fracture classification, complications and mortality were analysed. One hundred and three patients were included in the study. Fifty-nine were male, and the mean age was 34. The mean Revised Trauma Score (RTS) and Injury Severity Score (ISS) were 7.1 and 20, respectively. Pedestrian vs vehicle (59%), was the most frequent mechanism of injury. Twenty patients died (19%) most frequently due to "shock". Complications developed in 37 patients (36%), pneumonia being the most frequent. Age greater than 40 years (p=0.02), "shock" upon admission (p=0.002), a Glasgow Coma Scale (GCS) 2 (p 2 (p=0.007), and abdominal AIS>2 (p=0.03) all correlated with increased mortality. No correlation between pelvic fracture classification or fracture stability with mortality was observed. The outcome of patients with pelvic fractures due to blunt trauma correlates with the severity of associated injuries and physiological derangement on admission rather than with characteristics of or the type of fracture.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clinics (Sao Paulo)
                Title: Clinics
                Publisher: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                ISSN (Print): 1807-5932
                ISSN (Electronic): 1980-5322
                Publication date (Print): April 2011
                Volume: 66
                Issue: 4
                Pages: 629-634
                Affiliations
                [I ]Department of Radiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China.
                [II ]Sichuan Province Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wen Hua Lu, Nanchong, Sichuan 637000, China.
                [III ]State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China.
                Author notes
                E-mail: yangzg1117@ 123456yahoo.com.cn Tel.: 86-28-85423817
                Article
                Publisher ID: cln_66p629
                DOI: 10.1590/S1807-59322011000400018
                PMC ID: 3093794
                PubMed ID: 21655758
                SO-VID: a97051aa-845a-4ef9-b509-9a9850291a69
                Copyright © Copyright © 2011 Hospital das Clínicas da FMUSP
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 December 2010
                Date revision received : 17 January 2011
                Date accepted : 17 January 2011
                Page count
                Pages: 6
                Categories
                Subject: Clinical Science

                ScienceOpen disciplines: Medicine
                Keywords: pelvis,multidetector row computed tomography,digital radiography,earthquake,fracture
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: pelvis, multidetector row computed tomography, digital radiography, earthquake, fracture

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