title: Pelvic fracture in multiple trauma: A 67-case series.
abstract: Severe pelvic trauma remains associated with elevated mortality, largely due to hemorrhagic shock.
  
  
  
  The main study objective was to test for correlation between fracture type and mortality. The secondary objective was to assess the efficacy in terms of mortality of multidisciplinary management following a decision-tree in multiple trauma victims admitted to a level 1 trauma center.
  
  
  
  Between July 2011 and July 2013, 534 severe trauma patients were included in a single-center continuous prospective observational study. All patients with hemorrhagic shock received early treatment by pelvic binder. Patients with active bleeding on full-body CT or persisting hemorrhagic shock underwent arteriography with or without embolization. Pelvic trauma was graded on the Tile classification. The principle end-point was mortality.
  
  
  
  Median age was 40 years (range, 26-48 years), with a 79% male/female sex ratio. Thirty-two of the 67 patients with pelvic trauma (48%) were in hemorrhagic shock at admission. Median injury severity score (ISS) was 36 (range, 24-43). On the Tile classification, 22 patients (33%) were grade A, 33 (49%) grade B and 12 (18%) grade C. Overall mortality was 19%, and 42% in case of hemorrhagic shock. Mortality was significantly higher with Tile C than A or B (58% vs. 9.1% and 12.1%, respectively; P=0.001).
  
  
  
  Vertical shear fracture (Tile C) was associated with greater mortality from hemorrhagic shock.
  
  
  
  IV, case series.
authors.affiliation: Department of orthopedic and Trauma Surgery, hôpital Nord, chemin des Bourrely, 13015 Marseille, France. Electronic address: maximecaillot@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Caillot
authors.affiliation: Service d'anesthésie-réanimation, hôpital Nord, 13015 Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Hammad
authors.affiliation: Department of orthopedic and Trauma Surgery, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Le Baron
authors.affiliation: Service de biostatistiques, hôpital Timone-Adultes, 13015 Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Villes
authors.affiliation: Service d'anesthésie-réanimation, hôpital Nord, 13015 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of orthopedic and Trauma Surgery, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
authors.forename: X
authors.initials: X
authors.lastname: Flecher
mesh_terms: D000328:Adult; D000792:Angiography; D003663:Decision Trees; D004621:Embolization, Therapeutic; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000628:therapy*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy*; D010384:Pelvic Bones / Q000293:injuries*; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality*; D014193:Trauma Centers
keywords: Decision-tree; Mortality; Pelvic binder; Pelvic fracture; Tile classification