Management of severe pelvic fracture associated with injuries of adjacent viscera.
OBJECTIVE
To investigate the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.


METHODS
The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.


RESULTS
To cease massive bleeding due to pelvic fracture, ligation of internal iliac arteries was performed on 33 cases, and angioembolization on 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 8.86% (7/79); the main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4 cases, thrombosis of right common iliac artery in 1, ARDS following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.


CONCLUSIONS
Prompt diagnosis and proper treatment are the key to success. Devascularization of internal iliac arteries with external fixation cage of the pelvis, cystostomy and proximal sigmoidostomy are effective procedures in emergency treatment of the critical patients.
Gao
Jin-mou
JM
Department of Traumatology, Chongqing Emergency Medical Center, Chongqing 400014, China. gaojinmou2002@sina.com
Tian
Xian-yang
XY
Hu
Ping
P
Li
Chang-hua
CH
Wang
Jian-bai
JB
Zeng
Jian-bo
JB
D000007:Abdominal Injuries / Q000150:complications* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D016896:Treatment Outcome