Causes of mortality in patients with pelvic fractures

During 6 years we treated nearly 500 patients with pelvic fractures. Three hundred forty-eight were admitted directly to our hospital following blunt injuries; these patients formed the basis of this review. There were 220 men and 128 women with an average age of 31 years, a mean Injury Severity Score of 21.8, and an average hospital stay of 16.5 days. Almost two thirds of patients were injured in motor vehicle accidents, and about one eighth were pedestrians struck by a vehicle. Smaller numbers were injured in crushing accidents, motorcycle accidents, falls, and miscellaneous injuries. Only 32 patients (9%) had an isolated pelvic fracture. Associated injuries to the head, chest, abdomen, and upper and lower extremities were frequent, and these injuries often had a greater impact on outcome than the pelvic fracture. Twenty-eight patients died, an overall mortality rate of 8%. Only four deaths (14.3%) were a direct result of the pelvic fracture, and bleeding from a transected femoral artery contributed to one of these deaths. Most deaths were caused by severe head injury, nonpelvic hemorrhage, and multiple organ failure. Although the pelvic fracture may result in prolonged hospitalization, and can be a cause of extended disability, it is an infrequent cause of mortality.