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Treatment outcomes of open pelvic fractures associated with extensive perineal injuries
Ebrahim Ghayem Hasankhani1, Farzad Omidi-Kashani
1Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Open pelvic fractures with extensive perineal injuries lead to high mortality from bleeding and sepsis. Early management, including reanimation and surgical fixation, can improve patient outcomes and survival rates.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Open pelviperineal injuries present significant mortality risks, primarily due to uncontrollable hemorrhage and pelvic sepsis.
- Effective management strategies for these complex injuries are crucial for improving patient survival.
Purpose of the Study:
- To evaluate the management outcomes of open pelvic fractures complicated by extensive perineal injuries.
- To identify factors influencing patient outcomes in this high-risk trauma population.
Main Methods:
- Retrospective analysis of 15 patients with open pelvic fractures and extensive perineal injuries (urethral/anal lacerations).
- Data collected included injury mechanisms, severity scores, hemodynamic status, resuscitation needs, surgical interventions, complications, and mortality.
- Pelvic fractures were managed with external fixators, and perineal injuries with colostomy and debridement.
Main Results:
- The study included 15 patients (12 male, 3 female) with an average age of 38.6 years.
- Patients required significant blood transfusions (average 8 units PRBCs).
- Two patients (13.3%) died from hemorrhagic shock and septicemia, respectively. One patient experienced acute renal failure that resolved.
Conclusions:
- Open pelvic fractures with extensive perineal injuries are associated with a high mortality rate.
- Prompt diagnosis and comprehensive treatment, including resuscitation, colostomy, cystostomy, aggressive wound management, and external fixation, are vital for reducing mortality.
- Multidisciplinary care is essential for optimizing outcomes in these severe injuries.
Background:
The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries.
Methods:
We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis.
Results:
The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia.
Conclusions:
Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.
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