Analysis of pelvic fracture management

Analysis of pelvic fracture management based on the experience of 533 patients treated in a recent 5-year period is presented. Overall mortality was 6.4%. Of 190 (36%) 'complicated' pelvic fractures based upon the nature of the pelvic fracture itself or more often the associated injuries, the mortality was 18%. Management was facilitated by categorizing the complicated pelvic fractures into those in patients who arrived hemodynamically stable versus unstable. Mortality rates were 3.4% and 42%, respectively. Additional statistically significant differences between the two categories included age, types of pelvic fractures, and Injury Severity Scores. Further distinction of hemodynamically unstable patients unresponsive to the usual modaliities of resuscitation into those exsanguinating versus those in which a hypotensive yet stabilized state could be maintained also guided management. The significance of associated injuries, as they relate to the 34 pelvic fracture deaths, is stressed. In only four cases (0.75%) of all pelvic fractures seen, or 12% of all deaths, was the pelvic fracture unquestionably the major cause of mortality. In 53% of the deaths, the pelvic fracture played a contributing role; in 35% of the deaths, the fact that patients sustained a pelvic fracture was objectively considered inconsequential in the victim's unfortunate demise.