Pelvic injury patterns in blast: Morbidity and mortality

Area of Science:

• Trauma surgery
• Military medicine
• Injury epidemiology

Background:

• Blast trauma poses severe risks, with pelvic injuries being particularly critical.
• The incidence, mortality, and risk factors for blast-related pelvic trauma remain largely unquantified.
• Existing data lack assessment of clinical or radiological indicators for mortality in these cases.

Purpose of the Study:

• To determine the incidence and mortality of blast-mediated pelvic fractures.
• To identify clinical and radiological predictors of mortality in casualties with pelvic trauma.
• To assess the relative risk of specific injuries associated with blast-related pelvic fractures.

Main Methods:

• Analysis of the UK Joint Theater Trauma Registry (2003-2014).
• Inclusion of casualties with blast-mediated pelvic fractures from conflicts in Iraq and Afghanistan.
• Exclusion of casualties with severe injuries remote to the pelvis; computed tomography image analysis performed.

Main Results:

• 159 casualties identified with a 36% overall mortality rate.
• Pelvic vascular injury was present in all fatalities and had the highest relative risk of death (56% mortality).
• Unstable pelvic fractures, traumatic amputation, and perineal injuries were associated with a threefold increased risk of pelvic vascular injury.

Conclusions:

• Dismounted blast casualties with pelvic fractures face significant risk of noncompressible pelvic vascular injury.
• Initial management must prioritize control of noncompressible pelvic bleeding.
• Mitigation strategies targeting lateral pelvic displacement could reduce fatalities and injury burden.