Combat-related pelvis fractures in nonsurvivors

The purpose of this study was to describe pelvic fractures and their associated injuries in service members who either died of wounds or were killed in action during Operation Iraqi Freedom and Operation Enduring Freedom and define any differences in associated injuries between penetrating versus blunt injury to the pelvis.

A review of all service members who sustained a pelvis fracture during Operation Iraqi Freedom and Operation Enduring Freedom in the year 2008 was performed. Data were recorded for analysis.

One hundred four nonsurvivors were identified with pelvic fractures. Appropriate records, photos, and radiographs were available for 91, 70 were classified as "Not Survivable" (77%) and 21 "Potentially Survivable" (23%). Mechanisms of injury included 69 blast (76%), 14 gunshot wounds (15%), 4 motor vehicle accidents (4.5%), and 4 "other" (4.5%). Direct injury to the pelvis was penetrating in 60 (66%) and blunt in 31 (34%). Large pelvic vessel injury was observed more frequently in penetrating pelvic injuries (27%) than blunt injuries (3%). Hollow viscus abdominal injuries were more common in those with penetrating (57%) than blunt injuries (10%). There was an inverse relationship with intra-abdominal, solid organ injuries (blunt, 81%; penetrating, 55%). Head injuries were also more common in blunt pelvic injuries (blunt, 68%; penetrating, 45%), as were cardiopulmonary injuries (blunt, 84%, penetrating injuries, 57%).

Large pelvic vessel and hollow viscus injuries occur more frequently in penetrating combat-related pelvic fractures, whereas intra-abdominal solid organ, head, and cardiopulmonary injuries are more common in blunt pelvic injuries.