Pelvic Fracture from Major Blunt Trauma Outcome Is Determined by Associated Injuries

Abstract

Pelvic hemorrhage has been implicated as the cause of death in 50% of patients who die following pelvic fractures. To establish correlates of morbidity and mortality from pelvic fractures due to blunt trauma, we reviewed 236 patients treated during 4 years. The average age of the 144 men and 92 women was 31.5 years, the average Injury Severity Score was 21.3, the average blood requirement was 5 units, and the average hospital stay was 16.8 days. One hundred fifty-two patients (64.4%) were injured in motor vehicle accidents, 33 (14%) had motor vehicle-pedestrian accidents, 16 (6.8%) had crush injuries, 12 (5.1%) each had either motorcycle accidents or falls, and 11 (4.6%) had miscellaneous accidents. Eighteen patients (7.6%) died, with seven (38.9%) deaths due to hemorrhage. Only one death was caused by pelvic hemorrhage. Other deaths were due to hemorrhage from other sites (6), head injury (5), sepsis or multiple-organ failure (4), pulmonary injury (1), and pulmonary embolus (1). None of the septic deaths was related to a pelvic hematoma. Multivariate multiple regression analysis showed that the severity of injury was correlated with indices of severity of pelvic fractures such as fracture site (p less than 0.0001), fracture displacement (p less than 0.005), pelvic stability (p less than 0.0001), and vector of injury (p less than 0.01). However death could not be predicted on the basis of these indices of severity (p greater than 0.28). Of the nine patients who underwent pelvic arteriography, three required embolization of actively bleeding pelvic vessels, but seven had intra-abdominal hemorrhage that required laparotomy, and eight developed a coagulopathy. Massive bleeding from pelvic fractures was uncommon, and the major threat of hemorrhage was from nonpelvic sites. Furthermore, although injury severity was correlated with the severity of the pelvic fracture, hospital outcome was determined by associated injuries and not by the pelvic fracture.

What are Predictors of Mortality in Patients with Pelvic Fractures?

“…We identified the most frequent causes and time points of death in patients with pelvic ring fractures who did not survive. The mortality rate of our study population was 4%, lower than mortality rates reported by most previous studies [1, 5,6,14,15,20,21,25,27,35,36,38]. This reduction of mortality might be explained by constant progresses in the early treatment of pelvic ring injuries, including immediate mechanical stabilization of the pelvic ring and improved bleeding control techniques, but also by progresses in intensive care medicine and emergency management of multiple traumas [17,46].…”

“…However, in a substantial number of cases, mortality was not caused by the pelvic injury alone, but by a combination of multiple injuries to different body regions, including the pelvis. While brain injuries were consistently reported as a main reason for mortality in pelvic fracture patients, data from the literature on the incidence of lethal pelvic bleeding were conflicting [21,23,25,27,35,36]. This heterogeneity of data might have been due to the fact that isolated pelvic fractures were rarely lethal injuries, but a combination of pelvic and abdominal or thoracic bleeding often took a fatal course.…”

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

“…About 75% of all pelvic injuries occur in men [6] [7] [8] [9] [10]. The incidence of pelvic fracture resulting from blunt trauma increases with obese patients [11].…”

What Are Predictors for Patients’ Quality of Life After Pelvic Ring Fractures?

“…Pelvic ring fractures in young individuals are most commonly caused by high-energy trauma such as falls from a height or traffic accidents [20,21]. In the elderly, however, low-energy impacts often lead to fractures of the pelvic ring [4,21].…”