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Published on: November 8, 2024
Pelvic fracture in multiple trauma: A 67-case series
M Caillot1, E Hammad2, M Le Baron1
1Department of orthopedic and Trauma Surgery, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
Introduction:
Severe pelvic trauma remains associated with elevated mortality, largely due to hemorrhagic shock.
Objective:
The main study objective was to test for correlation between fracture type and mortality. The secondary objective was to assess the efficacy in terms of mortality of multidisciplinary management following a decision-tree in multiple trauma victims admitted to a level 1 trauma center.
Material And Methods:
Between July 2011 and July 2013, 534 severe trauma patients were included in a single-center continuous prospective observational study. All patients with hemorrhagic shock received early treatment by pelvic binder. Patients with active bleeding on full-body CT or persisting hemorrhagic shock underwent arteriography with or without embolization. Pelvic trauma was graded on the Tile classification. The principle end-point was mortality.
Results:
Median age was 40 years (range, 26-48 years), with a 79% male/female sex ratio. Thirty-two of the 67 patients with pelvic trauma (48%) were in hemorrhagic shock at admission. Median injury severity score (ISS) was 36 (range, 24-43). On the Tile classification, 22 patients (33%) were grade A, 33 (49%) grade B and 12 (18%) grade C. Overall mortality was 19%, and 42% in case of hemorrhagic shock. Mortality was significantly higher with Tile C than A or B (58% vs. 9.1% and 12.1%, respectively; P=0.001).
Conclusion:
Vertical shear fracture (Tile C) was associated with greater mortality from hemorrhagic shock.
Level Of Evidence:
IV, case series.
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