Paper presented
The outcome of open pelvic fractures in the modern era

Presented at the 57th Annual Meeting of the Southwestern Surgical Congress, San Antonio, Texas, April 10–12, 2005
https://doi.org/10.1016/j.amjsurg.2005.05.050Get rights and content

Abstract

Background

Recent series have reported that the mortality rate of open pelvic fractures has decreased to <10%. These injuries are often associated with intra-abdominal visceral damage, although few series have documented the prognostic significance of this injury complex.

Methods

A retrospective review in an urban level I trauma center of all patients who sustained open pelvic fracture between 1995 and 2004.

Results

Forty-four patients were identified as having sustained open pelvic fracture. Average Injury Severity Score was 30, with 77% of patients having a score ≥16. Overall mortality was 45% (n = 20): 11 early deaths and 9 late deaths at an average of 17 days. Vertical shear injuries, although rare, were universally fatal. Other risk factors for overall mortality included revised trauma score, Injury Severity Score, transfusion requirement, Faringer zones I or II injury, Gustilo grade III soft tissue injury, need for therapeutic angiography, and presence of intra-abdominal injury, the latter of which conferred 89% mortality. Risk factors for late deaths also included pelvic sepsis, which occurred in 5 patients and was fatal in 3 (60%).

Conclusions

The morbidity of open pelvic fractures remains high. Associated intra-abdominal injury or active arterial bleeding requiring therapeutic angiography is associated with a grim prognosis. There is a continuing need for new therapeutic approaches to this injury complex.

Section snippets

Materials and Methods

The records of 44 patients diagnosed with open pelvic fracture during a 10-year period, ending in December 2004, were reviewed. All patients were under the care of the Emory University Trauma Service at Grady Memorial Hospital, Georgia-state level I trauma center. The study was performed with the approval of the Emory University Institutional Review Board.

Patients were identified in the Trauma Registry of the American College of Surgeons (TRACS), and data were collected by reviewing the

Demographics and mechanism of injury

Between January 1995 and December 2004, 1506 patients with pelvic fractures were admitted to the Trauma Service of Emory University at Grady Memorial Hospital. Of these, 44 (3%) patients were identified with pelvic fractures that were considered to be “open” injuries. Demographic information is listed in Table 1.

In general, patients with open pelvic fractures were subjected to significant kinetic energy transfers, and, as such, associated injuries were common. The average injury severity score

Comments

In 4 series published in the 1970s and early 1980s, mortality rates associated with open pelvic fractures ranged from 42% to 58% [12], [13], [14], [15]. More recent series, however, have documented significantly lower mortality rates, with 8 series published in the 1990s (describing a total of 257 patients) averaging a mortality rate of 18% [4], [16], [17], [18], [19], [20], [21], [22]. Factors that have been associated with mortality include age, ISS, degree of bony injury, size of the open

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