MURUGA DASS MOHANA DASS(c11108764)

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK PADA BAGIAN ILMU BEDAH FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN MAKASSAR

INTRODUCTION
Pelvic fractures are result of high energy trauma Primary cause of death in patients due to resultant of blood loss The correlation of sufficient energy to disrupt the bony pelvis creates a devastating soft tissue injury that leads to transfusion and increased mortality Open fracture have mortality rate that approaches more than 50 %

INTRODUCTION
Open fractures are more likely to have rotationally or vertically unstable fracture patterns compared to closed fracture Risk factors for increased mortality from open pelvic fractures include injury severity score >25, a triage revised trauma score <8, an age of >65 years, initial systolic bp <100, GCS <8, blood transfusion of >10 units in 24h and colloid infusion of >6 liters in 24 hrs

INTRODUCTION

Management of open pelvic fractures has 4 elements

Control of hemorrhage Treatment of soft tisssue wound and prevention of sepsis Recognition and treatment of associated injuries Treatment of fracture itself

Attention to soft tissue preservation and skin care , appopriate ise of antibiotics , through irrigation and debridement and early ORIF with stable fixation has shown to reduce infection rates

MATERIALS AND METHODS

There were 27 492 patients which were admitted through Trauma Services at University of Tennessee Medical Center from January 1999- December 2009 In this cohort 3053 pelvic fractures were identified

Patients suffering pelvic fractures were further classified into blunt vs penetrating mechanism , open vs closed fractures and whether they receive angioembolization
Fractures were classified according to the Young- Burgess classification scales Each fracture type was then reviewed on hospital length of stay, itensive care unit length of stay , injury severity score , mortality and whether or not patient was discharged home

YOUNG- BURGESS TABLE

RESULTS
3053 pelvic fractures 231 deaths (6% mortality) Incidence of pelvic fracture (11%) Age 18-89 , mean age 44 years old; 1889 or 62 % male, 1164 females Hospital stay 1-110 days ICU lengths 0-101 days Injury severity score 4-75 , mean being 18.3

RESULTS
75% were be able to discharged home 19% transferred to various rehabilliation centres 52 open fractures (43 men & 9 woman; with mean age of 39 years {19.3-85.9}; Hospital stay 1-119 days; ICU stay 0-101 days; Injury severity score 4-50; 9 received angioembolization for control of bleeding; 10 deaths {mortality rate of 19%, 3 deaths from the angioembolization group }

RESULTS
Predominant mechanism of injury in open fracture is blunt force from a motorcycle crash; penetrating injury is 8 open pelvic fractures, all gunshot wounds ( treated with tetanus prophylaxis and antibiotics) Of the remaining 44 open pelvic fractures, 20 involved motorcycle crashes, 15 motor vehicle collisions, 4 falls, 4 industrial accidents, and 1 pedestrian struck by a vehicle.

RESULTS

Open fractures were further subdivided according only 29% of patients sustained an anteroposterior compression injury, the fracture pattern that would result from a head on collision.. There were ll LC Type I injuries, 10 LC Type II, 8 IC Type III, 1 AP Type 1, 3 AP Type II, and ll AP Type III.

Associated injuries were seen commonly with open pelvic fractures (shown in table)

RESULTS
Transfusions were required in 66% of patients. The average amount of blood transfused was 14 units. Mortality increased as the amount of blood transfused increased. There were no deaths in the patients who did not require blood transfusions. Four patients required in excess of 40 units of PRBCs, and of these patients, there were 2 deaths.

DISCUSSION
Open pelvic fracture in the institution, is associated with mortality was higher with than in closed pelvic fractures. The mortality rate from open pelvic fractures was 19% (10 deaths out of 52 patients). The mortality rate from closed pelvic fractures was 7.4% (221 deaths out of 3001 patients). Using a Fisher's exact test, the difference in mortality is statistically signicant with a p=0.0047.

DISCUSSION

For open pelvic fractures at the institution is 19%, which is Within previously reported range of mortality.7'1 Open pelvic fractures are usually the result of a high energy transfer and are most often seen as part of a blunt mechanism of trauma., but overall, injuries sustained from penetrating mechanisms to the pelvis are less morbid and without the signicant mortality as those sustained from blunt mechanisms. Open fracture is usually accompanied by many attendant injuries that maybe carry high morbidity and mortality itself

DISCUSSION

Many efforts have been employed to improve prehospital care and decrease transit times. Improved EMS care and techniques may bring patients who formerly would have expired in the eld to the medical center, which could potentially increase observed in-hospital mortality. Blunt trauma accounted for the vast majority of open pelvic fractures is known to be associated with higher morbidity and mortality than penetrating injuries. However, a dened resuscitation and xation strategy initiated by the trauma response team and coordinated with orthopaedic surgical teams still resulted in better outcomes and less mortality compared to classic histori- cal reports