Accuracy of reporting estimated blood loss in open  repair of pelvic and acetabular fractures

Background: Pelvic injuries after blunt trauma are often repaired with open reduction-internal fixation (ORIF), often resulting in high blood loss. We compare calculations of estimated perioperative blood loss (EPBL) against reported intraoperative blood loss (RIBL) by visual estimation to evaluate their accuracy during ORIF for pelvic fractures. Materials and Methods: A retrospective observational study was conducted at a Level 1 trauma center. 142 patients requiring ORIF of acetabular and/or pelvic ring fracture between ages 18 to 89 years from 3/1/2017 to 2/28/2019 were included. EPBL was calculated by Gross Method. Statistical analyses were conducted using R statistical software. Medians and inter-quartile ranges were used to summarize variables. A two-sample Wilcoxon signed rank test was performed. The agreement and reproducibility of RIBL and EPBL were examined with concordance correlation coefficients (CCC) and Bland-Altman plots. Results: Median RIBL was 450 mL [250, 800], while median EPBL was 2142 mL [1213, 3607]. The median difference was -1692 mL (p<0.001). The Bland-Altman plot showed consistent under-reporting in RIBL versus EPBL. A proportional bias (p<0.001), indicated that the level of bias was not constant between levels of blood loss. The CCC between RIBL and EPBL was 0.076 [-0.016, 0.167]. Pearson’s Correlation Coefficient was 0.213 (p=0.011). RIBL and EPBL had a weak positive correlation. Discussion: Blood loss during ORIF calculated by EPBL was significantly higher than RIBL. Our results suggest that blood loss reporting may be inaccurate in ORIF of pelvic fractures. These findings necessitate formulation of an accurate method permitting proper blood loss reporting. Keywords: postoperative blood loss; surgical blood loss; orthopedic surgery; estimation techniques

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Pelvic Fractures

Acta Radiologica ◽

10.1177/028418519403500504 ◽

1994 ◽

Vol 35 (5) ◽

pp. 420-425 ◽

Cited By ~ 5

Author(s):

J. Albrechtsen ◽

J. Hede ◽

A. G. Jurik

Keyword(s):

Femoral Head ◽

Pelvic Ring ◽

Posterior Part ◽

Conventional Radiography ◽

Pelvic Fractures ◽

Acetabular Fractures ◽

Pelvic Ring Fractures

Sixty-two patients with pelvic fractures were evaluated by conventional radiography and CT. A correct pathoanatomic classification of the fractures was most often obtained by conventional radiography, but CT added information regarding acetabular fractures and involvement of the posterior part of the pelvic ring. Besides, CT was essential in the detection of intraarticular fragments and lesions of the femoral head. Classification of pelvic ring fractures by the pattern of traumatic forces was easily obtainable by conventional radiography, but often difficult to achieve by CT.

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Accuracy of Reporting Estimated Blood Loss in Open Repair of Pelvic and Acetabular Fractures

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.449 ◽

2020 ◽

Vol 231 (4) ◽

pp. e170

Author(s):

Tanir Moreno ◽

Samudani Dhanasekara ◽

Nicole Van Spronsen ◽

Caroline Chung ◽

Cyrus Caroom ◽

...

Keyword(s):

Blood Loss ◽

Open Repair ◽

Acetabular Fractures ◽

Estimated Blood Loss

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Efficacy of repeated intravenous tranexamic acid in reducing perioperative bleeding of acetabular fractures

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211203 ◽

2021 ◽

pp. 1-7

Author(s):

Chen Xu ◽

Min Wu ◽

Zhaodong Wang ◽

Yajun Liu ◽

Pinghui Zhou ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Operative Time ◽

Total Blood Loss ◽

Postoperative Blood Loss ◽

Acetabular Fractures ◽

Control Group ◽

Transfusion Rate ◽

Total Blood ◽

Thrombosis Rate

BACKGROUND: Application of tranexamic acid (TXA) in the treatment of acetabular fractures could reduce intraoperative and postoperative blood loss. OBJECTIVE: To investigate the effect of single and repeated intravenous infusion of TXA on blood loss of acetabular fractures. METHODS: 120 patients with acetabular fractures admitted to our hospital from January 2017 to September 2020 were retrospectively divided into three groups: Patients accepted 1g TXA at preoperative 30 minutes were defined as single TXA group (n = 40); Patients accepted 1g TXA at preoperative 30 minutes and 1g TXA at 3 hours after the start of surgery were defined as repeated TXA group (n = 40); Patients accepted normal saline at preoperative 30 minutes were defined as control group (n = 40). RESULTS: The total blood loss in single TXA group and repeated TXA group were significantly lower than control group, and the total blood loss in the repeated TXA group was significantly lower than single TXA group (P < 0.05). The hidden blood loss from surgery to postoperative 1 day in repeated TXA group was significantly lower than single TXA group and the control group(P < 0.05). No significant differences were observed in the operative time, postoperative transfusion rate and thrombosis rate among the three groups (P > 0.05). CONCLUSION: Repeated TXA is more recommended during acetabular fracture surgery since it can reduce the total blood loss without increasing the operative time, postoperative transfusion rate and thrombosis rate compared with single TXA.

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The effect of prophylactic use of intravenous tranexamic acid in abdominal hysterectomy

Obsgyne Review: Journal of Obstetric and Gynecology ◽

10.17511/joog.2021.i01.01 ◽

2021 ◽

Vol 7 (1) ◽

pp. 1-5

Author(s):

Dr. Smita Barya ◽

◽

Dr. Sameer Goyal ◽

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Abdominal Hysterectomy ◽

Skin Incision ◽

Postoperative Blood Loss ◽

Abdominal Drain ◽

Estimated Blood Loss ◽

Group 2 ◽

Prophylactic Use ◽

Group 1

Introduction: Hysterectomy is one of the frequently performed major gynecological surgicalprocedures for various uterine pathologies. The objective of this study is to assess the effect ofintravenous tranexamic acid in reducing intraoperative and postoperative blood loss in womenundergoing abdominal hysterectomy. Materials and Methods: The study was a randomizeddouble-blind study, involving a total of 120 women undergoing abdominal hysterectomy for benignetiology were randomly assigned to two groups: Group 1 (non TA): (n=60) women receiving normalsaline and Group 2 (TA): (n=60) women receiving prophylactic Tranexamic Acid in 100 ml saline IVjust before skin incision. The primary outcome was intraoperative, postoperative, and all blood lossestimation. Results: Group 2 (TA) showed a great reduction in intraoperative and postoperativeblood loss (blood in the intra-abdominal drain) compared with Group 1 (non TA), (P = 0.0001,0.0001), so the overall estimated blood loss in groups 2 showed significant reduction compared withGroup 1 (P = 0.0001). Conclusion: Intravenous tranexamic acid is a safe and reliable method tohelp decrease blood loss during and after abdominal hysterectomy.

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NOVEL J-PLATE FOR ANTERIOR PELVIC RING INJURIES OSTEOSYNTHESIS

EurasianUnionScientists ◽

10.31618/esu.2413-9335.2021.4.85.1331 ◽

2021 ◽

pp. 22-28

Author(s):

A. Fain ◽

A. Vaza ◽

S. Gnetetskiy ◽

V. Bondarev

Keyword(s):

Blood Loss ◽

Surgical Approach ◽

Operative Time ◽

Pelvic Ring ◽

Operation Time ◽

Infectious Complications ◽

Long Term Results ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Pelvic Ring Fractures

The aim of the study was to evaluate the results of anterior pelvic ring fractures and acetabular fractures fixation with the specially designed plate by miniinvasive surgical approach. Materials and methods. 54 patients with anterior pelvic ring fractures and antrerior acetabular column admitted in Sklifosovsky Clinical and Research Institute for Emergency Care in the period from 2012 to 2020 year were analyzed. In 12 patients of the first group Judet-Letournel surgical approach was used. In 42 patients of the second group miniinvasive suprapubic and ilial surgical approach were used. In all patients novel J-plate was implanted. Mean operative time, mean blood loss, infectious complications were evaluated. Harris Hip Score for functional assessment after pelvic fractures was used for evaluation of long-term results. Results. Mean operative time in the first group was 181±25.4 min., mean blood loss amounted to 384±51.6 ml. Mean operative time in the first group was 98 ±21.5 min, blood loss - 183±59.8 ml. There were no infectious complications. The amount of good and excellent treatment results in the main group was 72%. Unsatisfied results amounted to 4%. Conclusion. J-plate for pelvic injuries fixation is indicated in patients with anterior column and anterior wall acetabular fractures associated with contralateral pubic bone fracture or pubic symphysis rupture. Combination of ilial and suprpubic surgical approaches can be used in less than 2 weeks after trauma to minimize operation time and blood loss.

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A COMPARISON OF THE EFFECTIVENESS OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN INFUSION IN REDUCING BLOOD LOSS IN FIRST TWO HOURS AT CAESAREAN SECTION

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i03.350 ◽

2021 ◽

Vol 31 (03) ◽

pp. 132-137

Author(s):

Mahham Janjua ◽

Maria Imran

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Controlled Trial ◽

Elective Cesarean Section ◽

Postoperative Blood Loss ◽

Singleton Pregnancy ◽

Estimated Blood Loss ◽

Sublingual Misoprostol ◽

Oxytocin Infusion ◽

Misoprostol Group

OBJECTIVE The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing intraoperative and postoperative blood loss with that of intravenous (IV) oxytocin infusion in the first two hours at cesarean delivery. STUDY DESIGN Randomized controlled trial PLACE AND DURATION OF STUDY The study was conducted in Lady Aitchison Hospital, Lahore unit IV-King Edward Medical University, and the duration of the study was one year. MATERIALS and METHODS Eighty-two women with term singleton pregnancy undergone elective cesarean section under spinal anesthesia were randomly allocated to receive either misoprostol 400 µg sublingually or IV infusion of 20 units oxytocin in 1000ml of normal saline soon after delivery of the baby. Estimated blood loss at the surgery and within the first 2 h post-operation were measured in both groups. Side effects in both groups were also recorded. RESULTS Mean blood loss with misoprostol was significantly less as compared to that of oxytocin. Post-operative hemoglobin was decreased by -4.95% in sublingual misoprostol and in the oxytocin group it was decreased by -9.33%. Blood transfusion and additional uterotonic therapy were significantly higher in the oxytocin group as compared to that of misoprostol. Nausea, vomiting, and hypotension was significantly higher in oxytocin group as compared to that of the misoprostol group. On the other hand, pyrexia and shivering were significantly higher in the misoprostol group. CONCLUSION The results of this trial showed that sublingual misoprostol is more effective as compared to intravenous oxytocin infusion in terms of reduction of blood loss in the first two hours at the cesarean section. It offers several advantages over oxytocin including long shelf life, stability at room temperature, and oral administration which makes it a suitable uterotonic agent in low-resource areas.

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Computer and magnetic resonance imaging for pelvic fractures in children

Medical Visualization ◽

10.24835/1607-0763-930 ◽

2021 ◽

Vol 25 (4) ◽

pp. 122-133

Author(s):

N. Yu. Serova ◽

T. A. Akhadov ◽

O. V. Karaseva ◽

I. A. Mel'nikov ◽

O. V. Bozhko ◽

...

Keyword(s):

Computed Tomography ◽

Road Traffic ◽

Bone Fractures ◽

Pelvic Ring ◽

Pelvic Fractures ◽

Pelvic Injury ◽

Acetabular Fractures ◽

Bone Lesions ◽

Posterior Pelvic Ring ◽

Fractures In Children

Introduction. Fractures of pelvic bones in children are rare and make up from 0.3 to 4% of all childhood trauma, 20% of children with polytrauma have pelvic ring injuries. Comparative studies of diagnostic capabilities of MRI and CT in sacral and acetabular fractures showed that about 37% of CT were missed, therefore the authors recommended MRI as the best method in visualizing pelvic fractures.Aim of this study is to show the capabilities of CT and MRI to improve recognition of pelvic fractures.Material and methods. In the period 2010–2019, 790 children with pelvic fractures as part of polytrauma were studied. The age of children was from 8.5 to 17 years, average 10.14 ± 1.4. Computed tomography with three-phase contrast was performed in all 790 patients on Brilliance 16 scanners. MRI was performed (n = 63) on a 3 T tomograph with obtaining multiplanar STIR, T1-, T2- and PD weighted images (VI) with signal suppression factor of adipose tissue, as well as 3D isotropic images.Results. On the polytrauma severity scale (ISS), the assessment of the condition of 790 children ranged from 23.54 to 27.5 (mean 25.77) points. The main mechanism of pelvic injury was road traffic accidents (pedestrian + passenger – 63.54% (n = 502), catatrauma was in second place – 32.66% (n = 258), followed by compression – 2.15% (n = 17) , sports injury – 0.38% (n = 3), other injury – 3.43% (n = 27). 73.26% (n = 578) had multiple pelvic fractures, 20.5% (n = 162) – complicated, – 22.3% (n = 176) unstable In 63 patients with damage to the anterior pelvic ring, according to CT, MRI revealed fractures of the posterior pelvic ring in 79.36% (n = 50).Conclusion. Children with polytrauma must undergo computed tomography to exclude not only all non-muscular-skeletal injuries, but also combined pelvic fractures. We believe that for the detection and assessment of bone fractures and concomitant injuries of other tissues and organs of the pelvis, in most cases, multiphase CT with intravenous contrast is a sufficient method. MRI is important for evaluating pelvic soft tissue structures such as tendons, ligaments, nerves and fascia, as well as detecting hidden / fine bone lesions.

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Pelvic Impairments

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2018.julaug02 ◽

2018 ◽

Vol 23 (4) ◽

pp. 9-10

Author(s):

James Talmage ◽

Jay Blaisdell

Keyword(s):

Pelvic Ring ◽

Reproductive Organs ◽

High Impact ◽

Pelvic Fractures ◽

Motor Dysfunction ◽

Impact Event ◽

Concomitant Injuries ◽

Rating Process ◽

Pass Through ◽

A Minor

Abstract Pelvic fractures are relatively uncommon, and in workers’ compensation most pelvic fractures are the result of an acute, high-impact event such as a fall from a roof or an automobile collision. A person with osteoporosis may sustain a pelvic fracture from a lower-impact injury such as a minor fall. Further, major parts of the bladder, bowel, reproductive organs, nerves, and blood vessels pass through the pelvic ring, and traumatic pelvic fractures that result from a high-impact event often coincide with damaged organs, significant bleeding, and sensory and motor dysfunction. Following are the steps in the rating process: 1) assign the diagnosis and impairment class for the pelvis; 2) assign the functional history, physical examination, and clinical studies grade modifiers; and 3) apply the net adjustment formula. Because pelvic fractures are so uncommon, raters may be less familiar with the rating process for these types of injuries. The diagnosis-based methodology for rating pelvic fractures is consistent with the process used to rate other musculoskeletal impairments. Evaluators must base the rating on reliable data when the patient is at maximum medical impairment and must assess possible impairment from concomitant injuries.

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The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649883 ◽

1995 ◽

Vol 74 (04) ◽

pp. 1064-1070 ◽

Cited By ~ 76

Author(s):

Marco Cattaneo ◽

Alan S Harris ◽

Ulf Strömberg ◽

Pier Mannuccio Mannucci

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Meta Analysis ◽

Postoperative Blood Loss ◽

Controlled Trials ◽

Double Blind ◽

Double Blind Placebo ◽

Transfusion Requirements ◽

The Mean ◽

Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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