[Injury of the pelvic ring and abdominal trauma]

Fractures and disruptions of the pelvic ring are usually found in multiply injured patients and exacerbate the life-threatening character of the concomitant injuries. The main prognostic factors are haemorrhagic complications, abdominal trauma and associated injuries of the urogenital tract. All patients admitted to the Department of Surgery of the University of Münster between July 1985 to December 1989 were analysed with particular reference to pelvic ring instability and the accompanying pelvic and abdominal lesions. Of 27 patients with unstable displaced lesions of the pelvic ring, 9 were female (33.3%) and 18 male (66.7%); the average age was 35.1 years. Multiple trauma was present in 25 patients (92.6%). Associated pelvic or abdominal injuries were found in 15 cases (55.6%) [multiple entries]. In 9 patients (33.3%) there were lesions of the urogenital tract. Injuries to pelvic blood vessels were diagnosed in 3 patients (11.1%). In 2 patients (7.4%) there were lesions of the perineum. A ruptured spleen was found in 4 patients (14.8%), lesions of the liver in 3 patients (11.1%), lacerations of the mesentery in 2 patients (7.4%). Bleeding into the mesentery, lacerations of serosa of the sigmoid colon and contusion of the pancreas were each seen in 1 case (3.7%). In 12 patients (44.4%) laparotomy was performed: The mortality in this series was 22.2% (6 patients). The authors propose a procedure for immediate diagnosis of these associated pelvic and abdominal injuries. The key factor for a favourable outcome is the differentiation between intraabdominal and retroperitoneal bleeding. A treatment algorithm is described. The value of laparotomy, interventional radiology and primary anterior stabilization of the pelvic ring with an external frame is discussed.