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Laparotomy and unstable pelvic fractures
1Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh, Scotland, United Kingdom.
Injury
|July 16, 2008
Summary
Laparotomy is often unnecessary for unstable pelvic fractures, leading to high mortality. Preoperative CT scans accurately identify intra-abdominal injuries, guiding surgical decisions and reducing negative laparotomies.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Unstable pelvic fractures frequently require surgical intervention, but the necessity of exploratory laparotomy is debated.
- High mortality rates are associated with major pelvic fractures and concurrent intra-abdominal injuries.
Purpose of the Study:
- To analyze the necessity of laparotomy in patients with unstable pelvic fractures.
- To evaluate the accuracy of preoperative investigations in identifying intra-abdominal injuries.
- To determine factors influencing negative laparotomy outcomes.
Main Methods:
- Retrospective analysis of 91 patients with unstable pelvic fractures.
- Classification of laparotomies as positive or negative based on findings.
- Comparison of pelvic fracture patterns with intra-abdominal injuries.
- Assessment of preoperative investigations, including CT scanning.
Main Results:
- Laparotomy was performed in 28 patients, deemed unnecessary in 8, with a 39% mortality rate (11 deaths).
- Vertical shear and combined mechanical injury patterns showed the highest incidence of abdominal injuries (28%), but fracture pattern was not a reliable predictor.
- Inadequate preoperative investigations contributed to negative laparotomies, with three such patients dying.
- Laparotomy was only necessary in 22% of cases.
- Preoperative CT scanning demonstrated 98% accuracy in identifying intra-abdominal injuries.
Conclusions:
- Laparotomy is frequently unnecessary in unstable pelvic fractures, contributing to significant morbidity and mortality.
- Preoperative CT scanning is a highly accurate and essential tool for determining the need for laparotomy.
- Minimizing negative laparotomies through improved preoperative assessment, particularly CT, can reduce mortality in these critically injured patients.
