Open Pelvic Fractures: Review of 30 Cases

Abstract

Background:Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval.Patients and Methods:In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%.Results:Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the last outpatient visit, the Faringer classification showed statistical significance on the need of colostomy (p = 0.001) in the acute phase of treatment.Conclusion:We suggest the routine use of the Jones classification for the emergency room assessment and management of all open fractures of the pelvic ring. We believe the Faringer classification seems to be useful for the abdominal surgeons for the indication of gut transit derivation but not for the acute management of the bony component of an open pelvic fracture.

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

“…Open pelvic fractures are a rare subset of pelvic ring fractures, comprising 2–4% of all pelvic ring fractures ( 1 , 2 ), that are the most severe, debilitating, and life-threatening of all the pelvic ring injuries. There is considerably high but also variable mortality reported with open pelvic fractures, between 4 and 41.8% ( 3 – 5 ). High-energy trauma is required to produce open pelvic fractures.…”

“…Open pelvic fractures, defined as a fracture of the pelvic bones that communicates with the external environment, through a wound in the adjacent soft tissue; skin, mucosa, vagina, or rectum ( 1 , 3 ). Bladder and urethral injuries are very common in patients with open pelvic fractures ( 6 ) however, associated injuries to the; thoracic spine, abdomen, head, and extremities are also likely ( 1 , 3 , 6 , 7 ).…”

“…Open pelvic fractures, defined as a fracture of the pelvic bones that communicates with the external environment, through a wound in the adjacent soft tissue; skin, mucosa, vagina, or rectum ( 1 , 3 ). Bladder and urethral injuries are very common in patients with open pelvic fractures ( 6 ) however, associated injuries to the; thoracic spine, abdomen, head, and extremities are also likely ( 1 , 3 , 6 , 7 ). Age >65 ( 1 , 7 – 10 ), fracture instability ( 1 , 8 , 10 ), revised trauma score (RTS) <8 ( 7 , 8 , 11 , 12 ), hypotension and shock on arrival ( 7 , 9 , 12 ), large wounds and contamination ( 1 , 10 ), Glasgow Coma Scale (GCS) <8 ( 7 , 8 ), rectal injury ( 1 , 10 , 11 , 13 ), and the amount of blood transfused in the first 24 h ( 1 , 7 , 8 ) were identified in the literature as factors that contribute to mortality in these patients.…”

“…Open pelvic fractures most frequently affect; previously healthy young males, causing chronic functional impairment and reduced quality of life (QOL) ( 14 ). The average Injury Severity Score (ISS) reportedly ranges from 21 to 46, demonstrating the presence of multiple severe injuries ( 1 , 3 , 4 , 7 , 8 , 13 ). Collisions involving; motor bikes, motor vehicles, and pedestrian, are responsible for most open pelvic fractures, with motor bike collisions being the most common mechanism ( 3 , 4 , 6 , 7 , 10 , 11 , 14 , 15 ).…”

Outcome of Haemodynamically Unstable Open Pelvic Fracture Patients Managed with “3-in-1” Pelvic Damage Control Protocol in a Major Trauma Centre

“…These patients usually also suffer from concomitant injuries of other limbs and organs. 1,2 The pelvic fracture itself leads to significant haemorrhage from bone, venous and arterial sources. Open fracture further complicates the situation with internal organ injuries and wound sepsis.…”