A protocolised approach provides a favourable outcome in patients with severe pelvic trauma.

Abstract

Background Pelvic fractures are often a result of injuries caused by a major force and lead to considerable morbidity and mortality. Despite advances in acute management protocols involving angioembolization as a prime intervention, mortality in complex pelvic fractures remains high. We analysed our experience with the outcomes of a pelvic trauma management protocol using surgical haemostatic techniques over 5 years. Methods We did a retrospective analysis of all patients admitted with pelvic factures from January 2014 to December 2018. Demographic profile, clinical details, imaging findings, operative details and outcomes were analyzed. Logistic regression analysis was used to determine factors predicting poor outcomes in patients with pelvic fractures. Results A total of 501 patients with pelvic fractures were included, predominantly male (376; 75%), with a mean (SD) age of 34 (13.1) years. Road traffic accidents were the most common cause of injury (362; 72.3%). On presentation, 76 (15.2%) patients were haemodynamically unstable. The most common pattern of pelvic fractures was lateral compression in 320 (63.9%). Seventy-nine patients (15.7%) died. Haemorrhagic shock (251; 50%) and sepsis (86; 34.2%) were the predominant causes of death. Multivariate analysis predicted a higher class of haemorrhagic shock and a high injury severity score was associated with poor outcomes of pelvic fractures. Conclusions Management of pelvic trauma is complex due to haemodynamic instability and multiple organ involvement. Our goal-directed, resource-directed approach provided an overall favourable outcome in patients with pelvic fractures.