Pelvic Ring Fracture in Older Adults After Minor Pelvic Trauma - Is It an Innocent Injury?

Pelvic Ring Fracture in Older Adults After Minor Pelvic Trauma - Is It an Innocent Injury?

Authors: Mahmoud Jammal, Khalil Nasrallah, Mahdi Kanaann, Rami Mosheiff, Meir Liebergall, Yoram Weil

Published in: Injury, August 2024

Conclusion: Severe pelvic hemorrhage following minor pelvic injury due to low-energy trauma in older adults is not an uncommon complication, especially in patients receiving anticoagulant therapy and with posterior pelvic ring fractures. This suggests that these injuries are more challenging than previously believed. Geriatric pelvic ring injuries should be closely monitored with serial blood counts and a low threshold for imaging, including contrast-enhanced CT scans and angiography.

Patients and Methods: This retrospective cohort study was conducted at an academic level 1 trauma center. It included 579 patients aged over 65 who sustained isolated low-energy pelvic fractures between 2006 and 2020. Pelvic computed tomography (CT) scans, with or without contrast, were performed and reviewed for patients with suspected posterior ring injury or bleeding. Patients without CT scans were excluded from the analysis.

Results: Of the 123 patients with isolated pubic rami fractures, 30 (24.4%) experienced bleeding, as evidenced by a significant hemoglobin drop (>2 g%). Among these, 21 patients (70%) had posterior pelvic ring involvement, compared to 45 patients who did not bleed (51%; p = 0.07). A significantly higher proportion of patients who received anticoagulant therapy (ACT) had posterior ring injury in the bleeding group (20% vs. 3.2%; p < 0.01). Treatment strategies included blood transfusion for 19 patients (15.5%) and arterial angiographic embolization for 5 patients (4%). There were no complications associated with angio-embolization, and all patients survived the initial 90-day period. No other sources of bleeding were identified.