Clin Orthop Surg.  2013 Dec;5(4):263-268. 10.4055/cios.2013.5.4.263.

Treatment Outcomes of Open Pelvic Fractures Associated with Extensive Perineal Injuries

• Hasankhani EG
• Omidi-Kashani F

• KMID: 1787028
• DOI: http://doi.org/10.4055/cios.2013.5.4.263

Abstract

BACKGROUND
The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries.
METHODS
We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis.
RESULTS
The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia.
CONCLUSIONS
Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

Keyword

Open fracture; Perineal injury; Pelvic fracture

MeSH Terms

Accidents
Adolescent
Adult
Aged
Child
Colostomy
Female
Fractures, Open/*surgery
Humans
Male
Middle Aged
Pelvic Bones/*injuries/*surgery
Perineum/*injuries/*surgery
Retrospective Studies
Shock, Hemorrhagic
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 An 18-year-old man motorcyclist had a head-on collision with a trailer. He had a type II anteroposterior compression open pelvic fracture with an associated extensive perineal injury and urethral tear, but focused abdominal sonography in trauma was negative. The patient underwent urgent perineal irrigation, debridement, cystostomy, and pelvic stabilization with external fixation device.

• 

  Fig. 2 Pelvic radiograph obtained after 31 days of hospitalization from the patient shown in Fig. 1. He underwent extensive debridement eight times. At the time of discharge, the cystostomy was closed and he was able to walk with the external fixator in place.

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