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Long-term outcomes in open pelvic fractures
F D Brenneman1, D Katyal, B R Boulanger
1Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Insights
Open pelvic fractures are severe orthopedic injuries. Survivors often face chronic pain, disability, and require significant transfusions and colostomies.
Area of Science:
- Orthopedic Trauma
- Injury Characteristics
- Patient Outcomes
Background:
- Open pelvic fractures are devastating orthopedic injuries.
- This study analyzes injury patterns, complications, mortality, and long-term quality of life.
Purpose of the Study:
- To document injury characteristics of open pelvic fractures.
- To assess complications, mortality, and long-term health-related quality of life.
Main Methods:
- Retrospective review of trauma registry data (1987-1995).
- Included blunt trauma patients with pelvic fractures (n=1,179).
- Long-term outcomes assessed via SF-36 and Functional Independence Measure.
Main Results:
- Open pelvic fractures occurred in 4% of patients.
- Open fracture patients were younger, more likely male, and had motorcycle crashes.
- Open fractures led to higher blood transfusion needs and infectious complications without colostomy.
Conclusions:
- Open pelvic fracture survivors often require massive transfusions and colostomies.
- Chronic pain and physical disabilities are common, impacting functioning and employment.
- Open pelvic fractures present unique challenges in orthopedic trauma management.
Background:
Open pelvic fractures represent one of the most devastating injuries in orthopedic trauma. The purpose of this study was to document the injury characteristics, complications, mortality, and long-term, health-related quality of life outcomes in patients with open pelvic fractures.
Methods:
The trauma registry at an adult trauma center was used to identify all multiple system blunt trauma patients with a pelvic fracture from January of 1987 to August of 1995 (n = 1,179). Demographic data, mechanism of injury, and fracture type were determined from hospital records. Short-term outcome measures included infectious complications, mortality, and length of stay in hospital. Long-term outcomes of survivors were obtained by telephone interview using the SF-36 Health Survey and the Functional Independence Measure.
Results:
Open pelvic fractures were uncommon, occurring in 44 patients (4%). Patients with open fractures were about 9 years younger, on average, than patients with closed fractures (30 vs. 39, p < 0.001). Similarly, patients with open fractures were more likely to be male (75 vs. 57%, p < 0.02), more likely to have been involved in a motorcycle crash (27 vs. 6%, p < 0.001), and more likely to have an unstable pelvic ring disruption (45 vs. 25%, p < 0.001). Open pelvic fracture patients required more blood than closed pelvic fracture patients, both in the first day (16 vs. 4 units, p < 0.001) and during the total hospital admission (29 vs. 9 units, p < 0.001). Five patients with perineal wounds did not receive a diverting colostomy; in turn, these individuals had a total of six pelvic infectious complications (one abscess, two with osteomyelitis, and three perineal wound infections). Overall, 11 patients died, six patients were lost to follow-up, and 27 were long-term survivors (mean duration of 4 years). Chronic disability was common after a pelvic fracture, with problems related to physical role performance and physical functioning, and was particularly severe after an open pelvic fracture (p < 0.05 for both as measured by the SF-36).
Conclusions:
Patients with open pelvic fractures often survive, need to be treated with massive blood transfusions, and often require a colostomy. They are frequently left with chronic pain and residual disabilities in physical functioning and physical roles, and many remain unemployed years after injury.