Abstract
Aim/Purpose
Review our unique experience in the management of 29 consecutive casualties who survived open pelvic fractures following a blast mechanism.
Methods and Results
Retrospective study utilising a prospectively collected combat trauma registry. Records of UK Service Personnel sustaining open pelvic fractures from an explosion from Aug 2008 – Aug 2010 identified. Casualties who survived to be repatriated to the Royal Centre for Defence Medicine, University Hospital Birmingham were selected for further study. The median New Injury Severity Score (NISS) was 41. Mean blood requirement in the first 24 hours was 60.3 units. In addition to their orthopaedic injury, 6 (21%) had an associated vascular injury, 7(24%) had a bowel injury, 11 (38%) had a genital injury and 7(24%) had a bladder injury. 8 (28%) fractures were managed definitively with external fixation, and 7 (24%) fractures required internal fixation. Of those patients who underwent internal fixation, 5 (57%) required removal of metalwork for infection. Faecal diversion was performed on 9 (31%) casualties. Median length of stay was 70.5 days, and mean total operative time was 29.6 hours. At a mean 20.3 months follow-up, 24 (83%) were able to ambulate, and 26 (90%) had clinical and radiological evidence of pelvic ring stability.
Conclusion
As a result of the “Global War on Terror” injuries that were previously confined exclusively to conflict areas can now occur anywhere in the form of terrorist attacks. Given the nature of the soft tissue injury, we would advocate an approach of predominantly external fixation in the management of these fractures. With the advent of emerging wound and faecal management techniques, we do not believe that faecal diversion is mandated in all cases.
