# Most blood loss, Femur or Pelvic Fracture?



## exitloy (Dec 10, 2018)

Just going over some study questions and i got a question wrong regarding most blood loss in a fracture.

I chose Pelvic fracture, but the answer was femur, but when i looked into it i found out a femur loses 1000 ml blood

Pelvic fracture said up 1500 ml of blood loss, which i confirmed from my textbook. I thought maybe i misread and it said blood held in the pelvic bones but nope, it said a pelvic fracture can cause 1500ml of blood loss.

so im curious why would femur be right, or what the NREMT would expect for an answer..

Another question is regarding pelvic fractures, what is the best method of splinting them? Spinal board for rapid transport or something like a pelvic splint/sheet?

thanks.


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## VFlutter (Dec 10, 2018)

A true Open Book Pelvic Fracture can result in more potential bleeding versus a femur fracute. A commercial pelvic binder is your best treatment followed by any makeshift binding.


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## Peak (Dec 11, 2018)

If a pelvic fracture is contained without disrupting the pelvic ring an adult can lose up to about 1.5L of blood, which is about the same as a femur fracture. If you disrupt the parapelvic fascia (which is seen in the classic open book pelvis fracture) you can essentially bleed freely into the abdomen up to you entire blood volume without an effective tamponade. 

Keep in mind that most pelvic fractures and the vast majority of femur fractures to not have any significant amount of blood loss (as is the case with the vast majority of fractures in general). We counterbalance this with the fact that without ultrasound or CT (or DPL/MRI depending on your trauma center's resources and standard of practice) there isn't a great way to determine pelvic/abdominal bleeding in the setting of trauma; add to this that in the setting of trauma pelvic or multiple long bone fractures are a indicator of more significant mechanism which is why most EMS will use it as a determinant for their transport decisions and EDs use it for trauma alerts. 

A commercial pelvic binder is ideal, however to be honest I've never been on a service that carries them nor have I ever had one in an ED I worked in. Back when I worked in a level I peds center there weren't any widely available pediatric pelvic binders so we always used a sheet. If a patient does present with an unstable hemorrhage as a result of pelvic fracture (as opposed to other concomitant insults from their trauma) they are going to require emergent surgical stabilization and even the best pelvic binder is only a temporizing measure. 

I love using a back board as a trauma spatula. It allows you to have something to secure the patient too and facilitate rapid transport from the ground into the bus or rotor, and then onto the stretcher in the ED (where we still typically keep a slide board under them until they are stable or transferred to OR or the unit). Back boards don't replace pelvic binders or traction splints but can help to facilitate their placement or securement.


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## VFlutter (Dec 12, 2018)

Whatever you use, just make sure you place it correctly at the Greater Trochanters, not the Illiac Crest.


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