Factors associated with mortality in combat-related pelvic fractures

Pelvic fractures were sustained by ≥26% of service members who died during Operation Enduring Freedom and Operation Iraqi Freedom in 2008. To determine factors associated with patient mortality following combat-related pelvic fracture (CRPF), the Joint Theater Trauma Registry database was searched to identify service members who survived CRPF sustained in the year 2008 (group 1), and the Armed Forces Medical Examiner System was searched to identify nonsurvivors of such trauma in the same year (group 2). Stable pelvic ring injuries were associated with a lower mortality rate than were unstable injuries when controlling for large-vessel and anatomic brain injuries (43% and 85%, respectively; P < 0.05). Associated injuries that were significant predictors of mortality included large-vessel, anatomic brain, cardiopulmonary, and solid organ abdominal (P < 0.05). Compared with a similar cohort of nonsurvivors, persons who survive CRPF have less severe pelvic fractures and associated injuries. In addition, pelvic fractures secondary to direct combat (ie, blast-related blunt injury, penetrating injury) were significantly more lethal than were those caused by mechanisms analogous to civilian trauma.