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Selective fecal diversion in complex open pelvic fractures from blunt trauma
P D Faringer1, R J Mullins, P D Feliciano
1Department of Surgery, Oregon Health Sciences University, Portland.
Objective:
To review the outcomes of patients with open pelvic fractures.
Design:
Retrospective review of medical records.
Setting:
Patients admitted from the injury scene or transferred within 24 hours to a level 1 trauma center.
Patients:
Thirty-three patients sustaining blunt trauma had pelvic fractures and adjacent wounding.
Interventions:
Treatment protocol that included selective fecal diversion, measures to arrest hemorrhage and prevent wound sepsis, manage associated pelvic injuries, and provide optimal orthopedic outcomes.
Main Outcome Measures:
Death and sepsis.
Results:
Exsanguination occurred in one patient and death owing to head injuries occurred in five patients. Wound sepsis occurred in 31% of patients with colostomy and 19% without colostomy.
Conclusions:
Management of open pelvic fractures requires a well-coordinated group using several techniques. Selected patients with open pelvic fractures do not require fecal diversion. Incisions for orthopedic surgery should be considered when decisions are made regarding fecal diversion.