BACKGROUND, OBJECTIVE AND METHOD: Management of patients with pelvic fractures requires a multidisciplinary team approach. Currently, survival has been dramatically improved but some controversies still remain. The purpose of this study was to examine management and results of treatment of patients with pelvic fractures who were admitted to the Trauma Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000.
RESULTS: There were 170 patients in the study. The age ranged from 15 to 91 years (mean 33.89 +/- 16.14). The most common cause of
injuries was motorcycle accidents (50.0%). There were 27 (15.9%), 47 (27.6%), 80 (47.1%) and 16 (9.4%) patients with Type I, II, III and IV pelvic fractures, respectively. Forty per cent of patients were in
shock when they first arrived at the emergency room. Seventy two patients (42.4%) had 274 associated
injuries. Sixteen patients (9.4%) had open pelvic fractures. The Injury Severity Score (ISS) ranged from 4 to 75 (mean 17.55 +/- 12.86). Eighty two patients (48.2%) received
blood transfusion from 1 to 40 units (mean 10.04 +/- 8.47). Sixteen patients (9.4%) underwent pelvic angiography, 10
bleeding points were demonstrated and successfully treated by transcatheter embolization. One hundred and thirty two patients (77.6%) received no specific treatment for the pelvic fractures. The remainder (22.4%) were treated with pelvic sling in 6 patients (3.5%), skeletal
traction in 21 patients (12.4%), external fixation in 6 patients (3.5%), internal fixation in 4 patients (2.4%), and right
hemipelvectomy in 1 patient (0.6%). Fifteen patients (8.8%) died. Causes of death were
exsanguination in 6 patients (40% of death), severe
head injuries in 6 patients (40% of death) and
sepsis with multisystem organ failure in 3 patients (20% of death). Nonsurvivors had a significantly higher ISS and units of
blood transfusion than survivors (P < 0.001). The
hospital stay ranged from 1 to 300 days (mean 24.7 +/- 34.19).
CONCLUSION: Approximately 75 per cent of patients in our study had major pelvic fractures (Type II and Type III pelvic fractures). The majority of
bleeding from pelvic fractures could be treated conservatively. Angiography with transcatheter embolization was extremely helpful when
conservative treatment failed to stop pelvic
bleeding. External fixation for early control of
bleeding pelvic fractures was infrequently employed.