Abstract：
BACKGROUND: Low-energy fragility fractures of the pelvis (FFP) are an underestimated entity, yet increasing in incidence. The bleeding risk for pelvic fractures in high-energy trauma is well known, resulting in adequate treatment guidelines and clear protocols. This is not the case for FFPs but this risk is presumably low. This study aims to investigate the clinically relevant bleeding risk, in patients older than 50 years with a fragility fracture of the pelvis admitted to the emergency department (ED).
METHODS: A retrospective cohort study was conducted of consecutive patients aged over 50 years with a FFP due to low-energy trauma (LET) presented to the ED of a single trauma center (North-West Clinics in Alkmaar, The Netherlands) between January 2018 and August 2022. The primary outcome was the percentage of patients requiring blood transfusion, or invasive procedures such as coiling by the interventional radiologists or damage control surgery, due to bleeding. Secondary outcomes were the mean decrease of hemoglobin and mortality.
RESULTS: In total, 322 consecutive patients with a mean age of 80 years of which 84% female were included. In total 66% was admitted to the hospital and seven patients underwent surgical intervention. Three cases (0.9%) of potentially clinically relevant bleeding were observed. These three cases needed a blood transfusion, without other interventions, and were all admitted with a low hemoglobin level without signs of hemodynamic instability. No invasive interventions were noted.
CONCLUSIONS: The risk of bleeding in FFP\'s is very low with very few patients requiring blood transfusions (< 1%) and with no invasive interventions due to bleeding. Since the risk of clinically relevant bleeding is low, the significance of repeated Hb checks and CECT may be questionable. The effect of these diagnostics in case of absence of hemodynamic instability and above borderline normal Hb levels needs to be investigated in further studies.
METHODS: A retrospective cohort study was conducted of consecutive patients aged over 50 years with a FFP due to low-energy trauma (LET) presented to the ED of a single trauma center (North-West Clinics in Alkmaar, The Netherlands) between January 2018 and August 2022. The primary outcome was the percentage of patients requiring blood transfusion, or invasive procedures such as coiling by the interventional radiologists or damage control surgery, due to bleeding. Secondary outcomes were the mean decrease of hemoglobin and mortality.
RESULTS: In total, 322 consecutive patients with a mean age of 80 years of which 84% female were included. In total 66% was admitted to the hospital and seven patients underwent surgical intervention. Three cases (0.9%) of potentially clinically relevant bleeding were observed. These three cases needed a blood transfusion, without other interventions, and were all admitted with a low hemoglobin level without signs of hemodynamic instability. No invasive interventions were noted.
CONCLUSIONS: The risk of bleeding in FFP\'s is very low with very few patients requiring blood transfusions (< 1%) and with no invasive interventions due to bleeding. Since the risk of clinically relevant bleeding is low, the significance of repeated Hb checks and CECT may be questionable. The effect of these diagnostics in case of absence of hemodynamic instability and above borderline normal Hb levels needs to be investigated in further studies.
摘要：
背景：骨盆低能量脆性骨折（FFP）是一个被低估的实体，发病率仍在增加。高能创伤中骨盆骨折的出血风险是众所周知的，导致适当的治疗指南和明确的方案。FFP的情况并非如此，但这种风险可能很低。本研究旨在探讨临床相关出血风险,急诊（ED）收治的50岁以上骨盆脆性骨折患者。
方法：进行了一项回顾性队列研究，连续50岁以上的患者因低能量创伤（LET）而患有FFP，并提交给单个创伤中心的ED（阿尔克马尔的西北诊所，荷兰）在2018年1月至2022年8月之间。主要结果是需要输血的患者百分比，或侵入性手术，如介入放射科医生的卷绕或损伤控制手术，因为出血。次要结果是血红蛋白和死亡率的平均下降。
结果：总计，包括322名平均年龄为80岁的连续患者，其中84％为女性。总共有66％的人入院，有7名患者接受了手术干预。观察到3例（0.9％）潜在的临床相关出血。这三个病例需要输血,没有其他干预措施，且均为低血红蛋白水平入院,无血流动力学不稳定迹象.没有发现侵入性干预措施。
结论：FFP的出血风险非常低，只有极少数患者需要输血（<1%），并且没有因出血而采取侵入性干预措施。由于临床相关出血的风险很低，重复Hb检查和CECT的意义可能值得怀疑。在没有血液动力学不稳定性和高于临界正常Hb水平的情况下，这些诊断的效果需要在进一步的研究中进行研究。
方法：进行了一项回顾性队列研究，连续50岁以上的患者因低能量创伤（LET）而患有FFP，并提交给单个创伤中心的ED（阿尔克马尔的西北诊所，荷兰）在2018年1月至2022年8月之间。主要结果是需要输血的患者百分比，或侵入性手术，如介入放射科医生的卷绕或损伤控制手术，因为出血。次要结果是血红蛋白和死亡率的平均下降。
结果：总计，包括322名平均年龄为80岁的连续患者，其中84％为女性。总共有66％的人入院，有7名患者接受了手术干预。观察到3例（0.9％）潜在的临床相关出血。这三个病例需要输血,没有其他干预措施，且均为低血红蛋白水平入院,无血流动力学不稳定迹象.没有发现侵入性干预措施。
结论：FFP的出血风险非常低，只有极少数患者需要输血（<1%），并且没有因出血而采取侵入性干预措施。由于临床相关出血的风险很低，重复Hb检查和CECT的意义可能值得怀疑。在没有血液动力学不稳定性和高于临界正常Hb水平的情况下，这些诊断的效果需要在进一步的研究中进行研究。
