Management of open pelvic ring injuries

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Emergency Medicine

Background:

• Open pelvic ring injuries are rare, severe trauma with high mortality rates (up to 50%).
• Lack of a defined treatment algorithm leads to conflicting evidence on wound management and fecal diversion.
• High mortality is attributed to exsanguinating hemorrhage, wound sepsis, and multiorgan system failure.

Purpose of the Study:

• To review current considerations and management strategies for open pelvic ring injuries.
• To evaluate the role of fecal diversion in reducing sepsis and late mortality.
• To highlight the need for further research to establish optimal treatment protocols.

Main Methods:

• Review of existing literature on open pelvic ring injuries.
• Analysis of factors influencing mortality, including hemorrhage, sepsis, and associated injuries.
• Discussion of current management principles: resuscitation, hemorrhage control, wound care, and skeletal fixation.

Main Results:

• Advancements in trauma care and ATLS protocols have improved survival rates.
• Classification systems exist for bony and soft tissue injuries.
• Fecal diversion has shown potential benefits in reducing sepsis, though evidence is limited.

Conclusions:

• Multidisciplinary care, aggressive resuscitation, hemorrhage control, and early surgical management are crucial.
• Fecal diversion may be beneficial in preventing sepsis and late mortality.
• Further large-scale studies are essential to define optimal treatment protocols for open pelvic ring injuries.