Complications of pelvic fractures from blunt trauma

Significant external forces are required to fracture a normal pelvis. These forces usually result from rapid deceleration or crushing injuries, and energy often is delivered to multiple anatomic sites in addition to the pelvis. Associated injuries are common, and numerous complications can occur in patients with pelvic fractures. During 4 years, the authors treated 144 men and 92 women with pelvic fractures from blunt trauma who were admitted directly to the University of Mississippi Medical Center. They had a mean age of 31.5 years, a mean Injury Severity Score of 21.3, and an average hospital stay of 16.8 days. Seventy-seven of the 236 patients (32.6%) had 137 complications, including 18 deaths. Most of these were infections such as pneumonia (6), urinary tract infections (8), wound infections (8), or sepsis without a defined source (10). There was a high incidence of pulmonary complications including Adult Respiratory Distress Syndrome (12), significant atelectasis (7), and fat emboli (3). Musculoskeletal complications (13) and coagulopathy (12) also occurred frequently. Eight patients had thromboembolic events, but prophylactic, subcutaneous heparin was not beneficial in preventing these complications. Patients with complications had higher Injury Severity Scores, lower Trauma Scores, increased transfusion requirements, longer hospital stays, and greater hospital charges compared to those without complications (P less than 0.01 for all variables). There was no association of complications with patient age, sex, mechanism of injury, anatomic site or amount of displacement of the pelvic fracture, or vector of injury. Patients with unstable pelvic fractures were much more likely to have complications than were those with stable pelvic fractures (P = 0.013).(ABSTRACT TRUNCATED AT 250 WORDS)