The role of pelvic fractures in the course of treatment and outcome of trauma patients.

BACKGROUND Pelvic fracture poses a complex challenge to the trauma surgeon. It is associated with head, thoracic and abdominal injuries. As pelvic fracture severity increases so does the number of associated injuries and the mortality rate. OBJECTIVES To report our experience in the treatment of pelvic fractures. METHODS Between October 1998 and September 2001, 78 patients with pelvic fractures were admitted to our hospital. The age range of the 56 male and 22 female patients was 16-92 (mean 42 years). The cause of injury was road accident in 52 patients, fall from a height in 15, a simple fall in 9, and gunshot wounds in 2 patients. The Glascow Coma Scale score on arrival at the hospital was 3-15 (average 12). Twenty-five patients (32%) were admitted to the intensive care unit, 38 (48%) to the orthopedic department, 5 (6.4%) to neurosurgery and the remainder to a surgical department. RESULTS Twenty-six patients (33.3%) received blood transfusion in the first 24 hours. Of the 25 patients with associated head trauma, 6 had intracranial bleeding (32%); 29 patients (37%) had associated chest trauma, 28 (35.9%) had associated abdominal trauma, 16 (20.5%) had vertebral fractures and 40 (51.2%) had associated limb fractures. Pelvic angiography was performed in 5 patients (6.4%), and computed tomography-angiography of the cervical arteries and chest was performed in 1 and 5 patients respectively. Overall, a CT scan was performed in 56 patients (71.8%), of whom 25 (32%) had a pelvic CT on admission. Injury Severity Score was 4-66 (median 20). Laparotomy was performed in 14 patients (18%), spinal fusion in 5 (6.4%), limb surgery in 16 (20.5%), cranial surgery in 4 (5.02%), pelvic surgery in 10 (12.8%), chest surgery in 3 (3.85%), and facial surgery in 2 patients (2.56%). Seven patients (9%) died during the course of treatment. CONCLUSIONS Pelvic fracture carries a high morbidity rate. Associated chest, abdomen and limb injuries are often encountered. A multidisciplinary approach is needed to improve survival and outcome in patients with pelvic fractures.