Journal of Surgery

Evaluation of Pelvic Volume Modification in "Open Book" Fractures Using a Three-Dimensional Model

Abstract

Árpád Török*, Krisztina E Vas, Mircea Muresan, Dénes Márton, Etele Élthes, Daniela Sala and Radu Mircea Neagoe

Background: The modification of the pelvic volume strongly influences the blood loss in “open book” fractures. Assessment of the degree of the changes helps in further management of the trauma patient.
Aim: The aim of this study was to create a three-dimensional pelvic model for the measurement of pelvic size. Methods: Using computer software we created three-dimensional models of the pelvis, based on CT images of 21 patients. To simulate an “open book” pelvic fracture we generated 2, 4, 6, 8 and 10 cm pubic disjunctions on the virtual model. In each modification we measured the pelvic diameters and we calculated the pelvic volume. The mathematical model used for calculation was the truncated elliptical cone.
Results: The mean pelvic volume was 1005.97 cm3. The transverse diameter increased significantly at 2 cm of pubic disjunction (p=0.0228). At 6 cm pubic disjunction significant modifications were noticed in promonto-suprapubic (p=0.0057) and biischiadic (p=0.0221) diameters. The pelvic volume increases significantly at only 4 cm pubic disjunction (p=0.0442). At 10 cm disjunction an increase of over 50% of the original volume occurred.
Conclusion: By measuring the pubic disjunction on CT image we can appreciate the pelvic volume increase. CT scan with bone visualization may be useful in previewing the magnitude of the hemorrhage in victims of blunt traumatic injuries associated with pelvic fracture, but further in vivo studies may be necessary.