The hemodynamic influence of the intrapelvic bleeding volume measured with three dimensional (3D) CT Volumetry by mechanic partially stable or instable pelvic ring fractures

Abstract

Introduction: Pelvic fractures, often resulting from high-energy trauma, pose significant challenges in emergency medicine and trauma surgery, particularly due to their association with substantial hemorrhage. The severity and complexity of these injuries necessitate accurate and timely assessment to guide management strategies. Traditionally, the emphasis on evaluating bleeding volume in pelvic fractures has focused on intrabdominal bleeding, with less attention given to intramuscular bleeding and fracture hematomas. Given the dynamic nature of hemorrhagic complications in trauma settings, this study explores the utility of 3D Slicer Volumetry in measuring bleeding volumes associated with unstable pelvic fractures, targeting primarily patients with Type B and Type C fractures. Goal: The primary aim of this research is to leverage advanced imaging techniques through 3D Slicer Volumetry to quantify bleeding volumes in patients with partially and completely unstable pelvic fractures. The investigation specifically seeks to: (1) determine differences in bleeding volume between pelvic fractures classified as Type B versus Type C by the AO Classification system; (2) evaluate the efficacy of 3D Slicer Volumetry as a viable clinical tool for defining bleeding volume; and (3) assess whether the quantified intracavitary bleeding correlates with overall blood loss in these traumatic injuries. Material and Methods: This retrospective study was carried out using data from 70 patients who sustained Type B or Type C pelvic fractures at the University Hospital of Giessen between 2016 and 2021. Inclusion criteria encompassed patients aged 14 years or older, experiencing stable clinical conditions upon arrival, and having undergone a full-body CT scan with contrast. Following data collection, 3D Slicer software was employed for the volumetric analysis of bleeding volumes, allowing interactive segmentation and comprehensive assessment of hematomas. Statistical analysis utilized non-parametric methods, particularly the Mann-Whitney U test, to compare bleeding volumes and clinical parameters across different fracture types. Key variables included age, gender, mechanism of injury, and laboratory findings at admission. Results: The findings indicate a predominance of pelvic fractures due to traffic accidents, encompassing 57.14% of cases. The average age of the patients was 49.98 years, with a male-to-female ratio of approximately 3:1. The mean volume of bleeding recorded was 591.9 ml (±455.4 ml). Notably, 42.86% of patients sustained Type B fractures, while the remainder had Type C fractures. Results demonstrated statistically significant differences in bleeding volumes between the two fracture types, with Type C fractures presenting greater hemorrhagic volumes. Systolic blood pressure upon admission was primarily above 89 mmHg in 90% of patients, indicating a relatively stable hemodynamic state despite significant injuries. The average duration of hospitalization was 33.55 days, reflecting the complexity of treatments necessitated by unstable pelvic fractures. Discussion: The results underscore the clinical relevance of accurately assessing bleeding volumes in pelvic fractures, which can significantly influence treatment pathways in trauma settings. The application of 3D Slicer Volumetry proved effective in providing precise measurements of bleeding volume, thus enhancing injury characterization. The observed trend of increased hemorrhage in Type C pelvic fractures reinforces the need for swift intervention and potential surgical exploration in cases of severe instability. Additionally, the study emphasizes the variable responses of patients to trauma based on age and sex, highlighting the need for tailored assessment protocols. While the results reveal promising data regarding the quantification of bleeding volumes, further research is warranted to correlate volumetric data with clinical outcomes and resource allocation in trauma care. Conclusion: This study demonstrates the feasibility and utility of using 3D Slicer Volumetry to evaluate bleeding volumes in patients with unstable pelvic fractures. The findings reveal critical differences in hemorrhagic profiles between fracture types, enhancing the understanding and management of pelvic injuries in trauma patients. Integration of advanced imaging techniques may facilitate improved outcomes through better-informed clinical decision-making in emergency trauma care. Future investigations should focus on longitudinal outcomes related to volumetric assessment and treatment effectiveness in pelvic fracture management.