Elsevier

Injury

Volume 31, Issue 9, November 2000, Pages 677-682
Injury

The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures

https://doi.org/10.1016/S0020-1383(00)00074-7Get rights and content

Abstract

In order to identify the prognostic factors and to evaluate the impact of associated injuries in the outcome of patients with pelvic fractures, a retrospective review of the medical records of patients admitted with a pelvic fracture during a 42-month period was carried out. Demographic data, the mechanism of injury, the physiologic status on admission, associated injuries, pelvic fracture classification, complications and mortality were analysed. One hundred and three patients were included in the study. Fifty-nine were male, and the mean age was 34. The mean Revised Trauma Score (RTS) and Injury Severity Score (ISS) were 7.1 and 20, respectively. Pedestrian vs vehicle (59%), was the most frequent mechanism of injury. Twenty patients died (19%) most frequently due to “shock”. Complications developed in 37 patients (36%), pneumonia being the most frequent. Age greater than 40 years (p=0.02), “shock” upon admission (p=0.002), a Glasgow Coma Scale (GCS)<9, Head AIS>2 (p<0.001), Chest AIS>2 (p=0.007), and abdominal AIS>2 (p=0.03) all correlated with increased mortality. No correlation between pelvic fracture classification or fracture stability with mortality was observed. The outcome of patients with pelvic fractures due to blunt trauma correlates with the severity of associated injuries and physiological derangement on admission rather than with characteristics of or the type of fracture.

Introduction

A pelvic fracture is an indicator of a severe trauma. In a frontal collision, an instantaneous deceleration of approximately 30-mph is required to disrupt the integrity of the pelvic ring [1]. The enormous amount of energy dissipated in such accidents is also responsible for associated injuries in other body regions which are present in 90% of the patients with pelvic fractures [2]. Retroperitoneal haemorrhage used to be reported as the most frequent cause of death following pelvic fractures.

Significant changes in the prognosis and outcome have occurred in the last 2 decades due to the refinements in angiographic embolization techniques as well as external and internal fixation [4]. Mortality rates have plateaued in the last decade ranging from 2 to 16% and associated injuries might play a significant role in the majority of the deaths [2], [4]. The incidence of post-traumatic complications varies from 32 to 50% and several studies have shown a significant correlation between the trauma score (TS), associated injuries, fracture type and stability, and “shock” with morbidity [2], [3], [5], [6], [7], [8], [9]. It is self evident that aggressive resuscitation, expeditious control of bleeding and adequate treatment of associated injuries are key components of a good outcome [9].

The objectives of this study are two-fold: (1) to analyse the impact of associated injuries in the outcome of patients sustaining pelvic fractures following blunt trauma, and (2) to determine other factors that might correlate with prognosis/outcome.

Section snippets

Methods

This is a retrospective analysis of all patients admitted with pelvic fractures during a 42-month period to the Emergency Service at Santa Casa School of Medicine in Sao Paulo, Brazil. This is a level-1 Trauma Centre serving a population of approximately 3 million.

We excluded patients transferred to our facility but initially seen in other hospitals, those with pathological fractures, isolated acetabular fractures, fractures due to penetrating trauma, open pelvic fractures, those dying within

Mechanism of injury

The most frequent mechanism of injury was of a pedestrian being struck by a vehicle (n=60; 59%) followed by motor vehicle accidents in 21 (20%), falls in 18 (17%), and other causes in four cases (3%).

Physiological status upon admission, trauma scores, and pelvic fracture grading

Thirty patients (29%) were in “shock” on admission. The mean RTS was 7.1±1.3, the mean ISS was 20±13, and mean Glasgow Coma Score (GCS) was 13±2. The mean probability of survival calculated using the TRISS methodology was 89±2 (%).

Forty-one patients (40%) had sustained grade I fractures, 29 (28%)

Discussion

Until the early 1980s retroperitoneal bleeding was the most frequent cause of death in patients with pelvic fractures [3], [7]. Recent studies have suggested that haemorrhage from associated injuries contribute significantly to deaths in patients sustaining pelvic fractures [7], [9]. The relevance of bleeding from associated injuries has been made more important after better methods of pelvic haemorrhage control were developed. External fixation, as well as angiographic embolization of bleeding

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