Long-term outcomes in open pelvic fractures.

BACKGROUND Open pelvic fractures represent one of the most devastating injuries in orthopedic trauma. The purpose of this study was to document the injury characteristics, complications, mortality, and long-term, health-related quality of life outcomes in patients with open pelvic fractures. METHODS The trauma registry at an adult trauma center was used to identify all multiple system blunt trauma patients with a pelvic fracture from January of 1987 to August of 1995 (n = 1,179). Demographic data, mechanism of injury, and fracture type were determined from hospital records. Short-term outcome measures included infectious complications, mortality, and length of stay in hospital. Long-term outcomes of survivors were obtained by telephone interview using the SF-36 Health Survey and the Functional Independence Measure. RESULTS Open pelvic fractures were uncommon, occurring in 44 patients (4%). Patients with open fractures were about 9 years younger, on average, than patients with closed fractures (30 vs. 39, p < 0.001). Similarly, patients with open fractures were more likely to be male (75 vs. 57%, p < 0.02), more likely to have been involved in a motorcycle crash (27 vs. 6%, p < 0.001), and more likely to have an unstable pelvic ring disruption (45 vs. 25%, p < 0.001). Open pelvic fracture patients required more blood than closed pelvic fracture patients, both in the first day (16 vs. 4 units, p < 0.001) and during the total hospital admission (29 vs. 9 units, p < 0.001). Five patients with perineal wounds did not receive a diverting colostomy; in turn, these individuals had a total of six pelvic infectious complications (one abscess, two with osteomyelitis, and three perineal wound infections). Overall, 11 patients died, six patients were lost to follow-up, and 27 were long-term survivors (mean duration of 4 years). Chronic disability was common after a pelvic fracture, with problems related to physical role performance and physical functioning, and was particularly severe after an open pelvic fracture (p < 0.05 for both as measured by the SF-36). CONCLUSIONS Patients with open pelvic fractures often survive, need to be treated with massive blood transfusions, and often require a colostomy. They are frequently left with chronic pain and residual disabilities in physical functioning and physical roles, and many remain unemployed years after injury.

[1]  J. Bender,et al.  Morbidity and timing of colostomy closure in trauma patients. , 1993, Injury.

[2]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[3]  C. Sherbourne,et al.  The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. , 1994 .

[4]  J. D. Richardson,et al.  Open pelvic fractures. , 1982, The Journal of trauma.

[5]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[6]  J. Raffa,et al.  Compound fractures of the pelvis. , 1976, American journal of surgery.

[7]  P. B. Hanson,et al.  Open fractures of the pelvis. Review of 43 cases. , 1991, The Journal of bone and joint surgery. British volume.

[8]  W. Fallon.  The present role of colostomy in the management of trauma , 1992, Diseases of the colon and rectum.

[9]  D. Trunkey,et al.  Selective fecal diversion in complex open pelvic fractures from blunt trauma. , 1994, Archives of surgery.

[10]  I. Shbeeb,et al.  Blunt pelviperineal injuries , 1982, Diseases of the colon and rectum.

[11]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[12]  L. Cook,et al.  Using Functional Independence Measure profiles as an index of outcome in the rehabilitation of brain-injured patients. , 1994, Archives of physical medicine and rehabilitation.

[13]  M. Rhodes,et al.  Open pelvic fracture: an injury for trauma centers. , 1992, American journal of surgery.

[14]  A. Peitzman,et al.  Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation. , 1995, The Journal of trauma.

[15]  E. Utiyama,et al.  Open pelviperineal trauma. , 1990, The Journal of trauma.

[16]  E. Mackenzie,et al.  Functional status following orthopedic trauma in young women. , 1994, The Journal of trauma.

[17]  C. Buerk,et al.  Pelvic fractures associated with open perineal wounds: a survivable injury. , 1993, The Journal of trauma.

[18]  R. Fischer,et al.  Open pelvic fracture: a lethal injury. , 1978, The Journal of trauma.

[19]  Marvin Tile,et al.  Acute Pelvic Fractures: I. Causation and Classification , 1996, The Journal of the American Academy of Orthopaedic Surgeons.