Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients

Abstract

Aim: It is difficult to treat delayed acetabular fractures due to massive blood loss during operation. Temporary balloon occlusion of the abdominal aorta was introduced into sacral tumor surgery to reduce intraoperative hemorrhage. The aim of this study was to investigate the effect of this method on reduction of intraoperative blood loss and analyze the complications of this technique in the treatment of delayed acetabular fracture. Methods: We retrospectively reviewed 43 patients with delayed acetabular fracture who were surgically treated through combined approaches. Nineteen patients underwent temporary balloon occlusion of the abdominal aorta; 10 patients had type B fracture and 9 patients had type C fracture according to the Müller AO classification. The remaining 24 patients were classified into a control group; 14 patients had type B fracture and 10 patients had type C fracture. Surgical time, intraoperative blood loss, blood transfusion, satisfactory reduction rate, and functional recovery were recorded and compared between two groups. Merle d'Aubigné and Postel scoring was applied to evaluate the patients. Results: The patients treated with intra-aortic balloon occlusion had a shorter surgical time (p = 0.008), less intraoperative blood loss (p = 0.005), and less transfused blood units (p = 0.001). No complications caused by balloon occlusion. No significant difference were observed in the outcomes and the complications related to acetabular fractures between two groups. Conclusions: Temporary balloon occlusion of the abdominal aorta is a reliable technique to control bleeding for the surgery of delayed acetabular fracture.

Keywords:

• old acetabular fracture
• abdominal aorta
• balloon occlusion
• hemorrhage
• operational technique

View addendum:

Intra-aortic Balloon Occlusion for Acetabular Fractures: Concept and Proof

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical statement

This study was approved by the Ethics Committee of Shanghai Sixth People's Hospital East Campus.

Figure 1 The anteroposterior radiograph shows acetabular fracture 25 days after the injury. (Type B, according to AO classification) with bilateral fractures of pubic ramus.

Note: A 60-year-old woman suffered from acetabular fracture due to traffic accident.

Figure 2 Exposing the femoral artery and inserting a Fogarty catheter into it.

Figure 3 Intraoperative image-intensifier view of intra-aortic balloon dilated with contrast medium, showing that the balloon was situated distal to the superior mesenteric artery and the renal artery.

Figure 4 The K-L approach and reduction and fixation of the fracture during surgery are shown.

Figure 5. The anteroposterior radiograph one month after surgery shows good reduction and fixation.

Declaration of Interests

No potential conflict of interest was reported by the author(s).