title: Assessment of pelvic fractures resulting from the 2010 Haiti earthquake: opportunities for improved care.
abstract: BACKGROUND
  On January 12, 2010, a catastrophic 7.0 magnitude earthquake shook the Haitian capital of Port-au-Prince. Because of their sudden and destructive nature, earthquakes can result in unfamiliar mass casualty situations accompanied by devastating orthopedic injuries. Evaluation of the pelvic fractures resulting from this earthquake revealed several factors that we hope will facilitate optimal preparation and planning for future disaster situations.
  
  
  METHODS
  A cohort of patients with earthquake-related pelvic ring fractures who were treated aboard the USNS Comfort was retrospectively analyzed. Anteroposterior radiographs of the pelvis were evaluated and categorized according to the Young-Burgess classification system.
  
  
  RESULTS
  Sixty-eight patients were included in the cohort. The mean (SD) age was 29.6 (14.4) years. Nineteen patients (29.7%) were male, and 49 (70.3%) were female. Pelvic fractures were categorized as anteroposterior compression in 7 patients, lateral compression (LC) in 47 patients, vertical shear (VS) in 8 patients, and combination of pelvic ring/acetabulum in 6 patients. Among the 23 patients treated operatively, the mean (SD) delay from injury to surgery was 19.2 (7.4) days.
  
  
  CONCLUSIONS
  Patients showed predominance toward LC injuries (69.1%), consistent with crush under rubble. Thirty-one percent of the fractures were considered unstable (anteroposterior compression Type III, LC Type III, VS, and combination of pelvic ring/acetabulum). The VS injuries observed (11.8%) may be the result of a previously unidentified injury mechanism, an upright individual being struck by falling rubble, violently applying a downward force to the body over an extended lower extremity. A substantial delay in the treatment observed in this series may lead to an underestimation of both quantity and severity of pelvic fractures as critically ill patients may have perished before evaluation and treatment. In addition, the application of pelvic sheeting techniques may be a lifesaving intervention for interval pelvic stabilization following earthquakes in which medical resources are scarce.
  
  
  METHODS
  Epidemiologic study, level III; therapeutic study, level V.
authors.affiliation: From the Department of Orthopaedic Surgery (S.K.D., E.C.C., M.T.A.), University of Cincinnati, Cincinnati, Ohio; Department of Orthopaedic Surgery (C.N.M.), Uniformed Services University of the Health Sciences, Naval Medical Center, Portsmouth, Virginia; and Department of Orthopaedic Surgery (A.R.B.), University of Texas Health Sciences Center at Houston, Houston, Texas.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dailey
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Casstevens
authors.forename: Michael T
authors.initials: MT
authors.lastname: Archdeacon
authors.forename: Christiaan N
authors.initials: CN
authors.lastname: Mamczak
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Burgess
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004189:Disaster Planning; D004190:Disasters; D055866:Earthquakes; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult