title: Innominosacral dissociation: mechanism of injury as a predictor of resuscitation requirements, morbidity, and mortality.
abstract: OBJECTIVE
  To assess mechanism of injury as a clinical course predictor in patients with complete anterior and posterior pelvic ring disruptions [innominosacral dissociation (ISD)].
  
  
  METHODS
  Retrospective review of radiographs and medical data.
  
  
  METHODS
  R Adams Cowley Shock Trauma Center, Baltimore, Maryland, statewide trauma center.
  
  
  METHODS
  Forty-three patients with ISD were admitted to our institution between August 1986 and October 1991. Five patients were excluded because of incomplete medical records (4) or refusal of blood transfusion (1).
  
  
  METHODS
  Injuries were grouped according to the Young classification: 18 anteroposterior compression (APC), 14 vertical shear (VS), and 6 other injuries.
  
  
  METHODS
  The mean blood replacement requirements, incidence of multiple organ system failure, mortality rate, and length of hospital stay for each injury classification were compared.
  
  
  RESULTS
  The mean ISS was 34, and the mean 24-hour packed red blood cell transfusion requirement was 12.6 units. Thirteen patients (34.4%) developed multisystem organ failure. Eight patients (21%) died. Patients in the APC group were more likely to require > or = 10 units of blood (15/18, p = 0.001, and those in the VS group were more likely to receive < 10 units (11/14, p = 0.0014). Multisystem organ failure occurred more frequently (11/18 versus 2/14; p < 0.005), mortality was significantly higher (39 versus 0%, respectively; p = 0.01), and mean hospital stay for survivors was longer (48 versus 27 days; p < 0.025) in the APC than in the VS group, respectively.
  
  
  CONCLUSIONS
  These findings suggest that mechanism of injury is an important determinant of clinical behavior in patients with IDS, and that ISD secondary to the APC mechanism is associated with substantially greater resuscitation requirements, morbidity, and mortality than ISD secondary to the VS mechanism.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore 21201-1595, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Whitbeck
authors.forename: H J
authors.initials: HJ
authors.lastname: Zwally
authors.forename: A R
authors.initials: AR
authors.lastname: Burgess
mesh_terms: D000293:Adolescent; D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011379:Prognosis; D011859:Radiography; D012042:Registries; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries*; D015996:Survival Rate