Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation

• Published in: European journal of orthopaedic surgery & traumatology
• Main Authors: Zusman, Natalie L, Peterson, Danielle F, Lawson, Michelle M, McKibben, Natasha S, Gallacher, David M, Friess, Darin M, Working, Zachary M
• Format: Journal Article
• Language: English
• Published: France 14.06.2023
• Subjects: Acetabular fracture; Pelvic fracture; Orthopaedic trauma; Bladder shift; Acute trauma care; Intraoperative blood loss
• ISSN: 1432-1068; 1432-1068
• DOI: 10.1007/s00590-023-03617-8

The purpose of this study was to characterize the relationship between a novel radiographic measurement on initial AP pelvis radiograph (termed "bladder shift," BS) to intraoperative blood loss (IBL) during acetabular surgical fixation. All adult patients receiving unilateral acetabular fixation (Level 1 academic trauma; 2008-18) were reviewed. AP pelvis radiographs were reviewed for visible bladder outlines and then measured to determine the percentage deformation toward the midline. Hemoglobin & hematocrit data were then used to calculate quantitative blood loss between pre- and post- operative blood counts for data analysis. 371 patients with unilateral traumatic acetabular fractures requiring fixation were reviewed; 99 of these had visible bladder outlines, complete blood count and transfusion data (2008-2018; 66% associated patterns). Median bladder shift (BS) was 13.3%. Every 10% of bladder shift was associated with 123 mL greater IBL. Patients with full bladder shift to midline sustained a median 1.5L IBL (interquartile range [IQR] 0.8 to 1.6). Associated patterns had a threefold greater median BS (associated: 16.5% [15.4 to 45.9] vs. elementary: 5.6% [1.1 to 15.4], p < 0.05) and received intraoperative pRBC twice as frequently (57% vs. 24%, p < 0.01). Radiographic bladder shift is an easily available visual marker, in patients sustaining acetabular fractures, that may predict intraoperative hemorrhage and need for transfusions.