Laparotomy and unstable pelvic fractures

The requirement for laparotomy was analysed in 91 patients with unstable pelvic fractures. Laparotomies were classified as positive or negative. Injuries found at laparotomy were compared with the pelvic fracture pattern. Laparotomy was carried out in 28 patients but was unnecessary in 8. Eleven of the 28 patients died, a mortality of 39%. Vertical shear and combined mechanical injury pelvic fracture patterns had the highest incidence of abdominal injuries (28%) but the fracture pattern was not a reliable guide to the presence or nature of intra-abdominal injury. Inadequate preoperative investigations contributed to the eight negative laparotomies and three of these patients died. Laparotomy was only necessary in 22% of our patients. Major pelvic fractures with concomitant intra-abdominal injuries have a high mortality rate. Preoperative CT scanning was 98% accurate in the identification of intra-abdominal injury and was the most useful investigation for determining the need for laparotomy and minimising the risk of negative laparotomy.