[Severe pelvic fractures, associated injuries and hemodynamic instability: incidence, management and outcome in our center].
BACKGROUND
The aim of this study was to review the incidence, treatment and outcome of severe pelvic fractures, as well as associated injuries, in our center.


METHODS
We performed a retrospective study of patients included in our trauma registry between June 1993 and January 2005. Pelvic fractures were classified according to the system proposed by Tile. Clinical and demographic data such as age, gender, mechanism of injury, transfer time, hemodynamic status, and trauma scores were compared and analyzed statistically. Shock was defined as a systolic blood pressure of < or = 90 mmHg during the primary assessment. Mortality and associated risk factors were analyzed, with emphasis on patients in shock on admission.


RESULTS
Of 1274 patients with severe trauma admitted during the study period, 192 (15%) had pelvic fracture. Only 6.7% were isolated fractures and 6% were open fractures. Twenty percent of the patients were in shock on admission. The mean Injury Severity Score of the series was 28.5 +/- 14 and that of patients in shock was 38 +/- 16. The most frequently associated injuries were thoracic (70%), abdominal (55%), long bone fractures (52%), and head injuries (40%). Twenty-three percent of the patients had retroperitoneal hematoma. Arteriograms were performed in 16 patients, with four embolizations. Eight patients underwent external orthopedic fixation, and none posterior orthopedic fixation. Five patients underwent pelvic packing and two patients underwent ligation of hypogastric arteries. Overall mortality was 30% and mortality in patients in shock was 61%. Predictors of mortality were shock on admission, a Glasgow Coma Scale score of < or = 8, ISS > 25 and age > 55 years.


CONCLUSIONS
Patients in shock with pelvic fractures have a poor prognosis in our center, frequently related to the severity of associated injuries, the relative rarity of these fractures, and the lack of a clearly defined management protocol. The main cause of death was massive hemorrhage.
Sánchez-Tocino
Juan María
JM
Sección de Cirugía de Urgencia, Departamento de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España.
Turégano-Fuentes
Fernando
F
Pérez-Díaz
Dolores
D
Sanz-Sánchez
Mercedes
M
Lago-Oliver
Jesús
J
Zorrilla-Ortúzar
Jaime
J
Martínez-Baena
Darío
D
D000007:Abdominal Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply* / Q000293:injuries*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome