title: Open-book pelvic fractures with perineal open wounds: a significant morbid combination.
abstract: Open-book pelvic fractures (OBPF) with concomitant intra-abdominal injuries carry a high morbidity and mortality; the significance of associated perineal open wound (OBPF-POW) has not been defined. We hypothesize that the presence of perineal open wounds increases morbidity, mortality, and concomitant use of hospital resources. Patients diagnosed with OBPF over a 5-year period at a Level I trauma center were identified by trauma registry review, and were retrospectively reviewed under an Institutional Review Board-approved protocol. Patients with OBPF without a perineal open wound were compared with those with OBPF-POW. Data collected included patient demographics, injury details, management, and outcomes. A total of 1,635 patients with blunt pelvic fractures were identified, of which 177 (10.8%) had OBPF. OBPF-POW (36/177) significantly increased the use of angioembolization, occurrence of sepsis, pelvic sepsis, ARDS, and multi-organ system failure. Patients with OBPF-POW had an increase of 13 days in length of hospitalization compared with the OBPF group (P < 0.001), with cost of $120,647.30 and $62,952.72 respectively (P < 0.001). Perineal open wounds complicate open-book pelvic fractures with significant increase in hospital resource utilization. Aggressive multidisciplinary evaluation and management is appropriate to detect and prevent complications.
authors.affiliation: Department of Surgery and Anesthesia, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA. jduchesn@tulane.edu
authors.forename: Juan C
authors.initials: JC
authors.lastname: Duchesne
authors.forename: Husain M
authors.initials: HM
authors.lastname: Bharmal
authors.forename: Arash A
authors.initials: AA
authors.lastname: Dini
authors.forename: Tareq
authors.initials: T
authors.lastname: Islam
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmieg
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Wahl
authors.forename: John A
authors.initials: JA
authors.lastname: Davis
authors.forename: Peter
authors.initials: P
authors.lastname: Krause
authors.forename: Norman E
authors.initials: NE
authors.lastname: McSwain
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology; D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D010384:Pelvic Bones / Q000293:injuries*; D010502:Perineum / Q000293:injuries*; D011379:Prognosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult