The aim of present study was to evaluate the clinical evolution of a series of 60 pelvic fractures with uncontrolled hypotension treated with combined ex fix/angio algorithm based on fracture pattern.

Materials and Methods: Retrospective study. We analysed 60 patients admitted between 2000 and 2008 with pelvic fracture and haemodinamic instability, treated by the same treatment algorithm. Decision-making (angio vs external fixation) was based on fracture type and hypotensive pattern. Key points were: immediate pelvic sheeting, early CT scan if possible and early arteriogram if contrast blushing in CT. Patients with rotationally unstable fractures were treated by external fixation and those with vertically unstable or stable pattern were transferred to angio suite. Patients with hemoperitoneum detected by fast were transferred to OR for laparotomy and external fixation.

Inclusion criteria: pelvic fracture, SAP< 90mmHg, ISS> 16, RBT > 800cc in first 24 hours. Exclusion criteria: Traumatic brain injury with AIS> 3.

Results: Mean ISS: 31.2, mean RBT: 4859 cc. Most fractures were C1 Tile. External fixation was used in 38 patients (63%) and 51 (85%) patients were treated initially by angio. We found active arterial bleeding in 48 cases. Successful embolization was achieved in 85%. Both treatments was used in 23 patients. Laparotomy was performed in 21 patients. Incidence of systemic complications was high. Mortality was 21 %.

Conclusions:

Arterial lesions demonstrated by arteriogram were high in our study.

Introduction and Objectives: Lesions due to falls cause a combination of skeletal lesions that require specific treatment. The aim of this study is to determine the epidemiological and evolutionary profile of a group of patients with severe trauma due to falls.

Materials and Methods: We carried out an analysis of the register of the Hospital Trauma Service. The variables we studied were: demographic; scores: the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS); probability of survival, type of lesion and evolution data.

Results: Between 2003 and 2008, 190 patients were admitted due to falls. Mean age was 39 years. And 85.3% were men, 100% of the falls were at work and 62% were suicide attempts. Mean ISS: 27.3; mean NISS: 34.1. The severity expressed by ISS and NISS was higher in the group of patients that had suffered falls than in those with lesions due to other causes. Mean probability of survival was 81%, 65% for suicide attempts. The main causes of falls were work-related 40%, accidental 24.7% and attempted suicide 22%. There was a greater incidence of attempted suicides in women and foreigners. The mean height of the falls was 9.7 m. The most frequently affected bone was the tibia, with 56 fractures. There were 51 pelvis fractures. The most frequent combined lesion was lesion of the pelvic bone together with a lesion of a long bone of the leg, 13 cases. Global mortality was 14.2%, with 17.1% in the worker group and 21% in the suicide group.

Discussion and Conclusions: In our environment there is a high rate of lesions due to falls. The severity of the lesions scored by ISS and NISS is greater than for lesions due to other causes that are not falls.