Associated abdominal injuries do not influence quality of care in pelvic fractures—a multicenter cohort study from the German Pelvic Registry

Abstract

Background: Pelvic fractures are rare but serious injuries. The influence of a concomitant abdominal trauma on the time point of surgery and the quality of care regarding quality of reduction or the clinical course in pelvic injuries has not been investigated yet. Methods: We retrospectively analyzed the prospective consecutive cohort from the multicenter German Pelvic Registry of the German Trauma Society in the years 2003-2017. Demographic, clinical, and operative parameters were recorded and compared for two groups (isolated pelvic fracture vs. combined abdominal/pelvic trauma). Results: 16.359 patients with pelvic injuries were treated during this period. 21.6% had a concomitant abdominal trauma. The mean age was 61.4 ± 23.5 years. Comparing the two groups, patients with a combination of pelvic and abdominal trauma were significantly younger (47.3 ± 22.0 vs. 70.5 ± 20.4 years; p < 0.001). Both, complication (21.9% vs. 9.9%; p < 0.001) and mortality (8.0% vs. 1.9%; p < 0.001) rates, were significantly higher. In the subgroup of acetabular fractures, the operation time was significantly longer in the group with the combined injury (198 ± 104 vs. 176 ± 81 min, p = 0.001). The grade of successful anatomic reduction of the acetabular fracture did not differ between the two groups. Conclusion: Patients with a pelvic injury have a concomitant abdominal trauma in about 20% of the cases. The clinical course is significantly prolonged in patients with a combined injury, with increased rates of morbidity and mortality. However, the quality of the reduction in the subgroup of acetabular fractures is not influenced by a concomitant abdominal injury.

A comparison on the detection accuracy of ante mortem computed tomography vs. autopsy for the diagnosis of pelvic ring injury in legal medicine

“…Therefore, it is of significant forensic relevance to evaluate pelvic structures in detail. Pelvic fractures in particular are associated with fatal bleeding and are associated with collateral abdominal and urogenital injuries [5][6][7]. If present, pelvic fractures can double the mortality of multiple injured patients [3].…”

Current updates in management of extremity injuries in polytrauma

“…However, a postponement over three weeks has been proven to be associated with a worse surgical outcome, especially regarding reduction quality in pelvic and acetabulum fractures. 43,45 Further, Glass et al reported a significant decrease in clinically relevant surgical site infections, following definitive early fracture fixation, including long bones, pelvic ring, acetabular fractures, and spinal fusions, even in the presence of an open abdomen when compared with delayed fracture fixation. 44 Similarly, Vallier et al reported that early definitive fracture fixation including spine fixations are safe in polytrauma patients as part of the "Early Appropriate Care" protocol 26 .…”

Pedicle screw-rod fixation and pelvic external fixation for the treatment of unstable pelvic ring fracture

“…Unstable pelvic fracture is the manifestation of pelvic ring destruction under direct or indirect violence which may be life-threatening [12]. It requires a careful and interdisciplinary decision-making regarding the therapeutic regime [2]. The principle of early diagnosis and treatment is to maintain hemodynamic stability.…”

“…Unstable pelvic ring fracture is severe injuries, related with high-energy trauma [1]. Main causes are tra c accidents or falls from different heights [2]. High mortality and complication rates are associated with hemodynamic instability and mechanical malfunction of pelvic ring [3].…”