Management and outcome of pelvic fractures in elderly patients: a retrospective study of 40 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.</p><p><b>METHODS</b>We retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010.</p><p><b>RESULTS</b>A total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency.</p><p><b>CONCLUSIONS</b>Pelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.</p>

Early diagnosis and treatment of pelvic fracture with vaginal injury / 中华骨科杂志

Objective To investigate the early diagnosis and treatment of pelvic fracture with vaginal injury.Methods From January 2000 to July 2010,13 patients suffered from pelvic fracture with vaginal injury were treated in our hospital,whose average age was 31.7 years.According to the Tile classification,there were 4 cases of type B1,1 case of type B2,4 cases of type B3,3 cases of type C1,and 1 case of type C2.Emergency repair of vagina together with open reduction and internal fixation of pelvic fracture was performed in 3 patients.After the patients' condition became stable,5 patients with shock were treated with emergency repair of vagina together with primary external fixation of pelvic fracture.Prompt repair of vagina together with open reduction and internal fixation or primary external fixation of pelvic fracture was performed in 2 patients who underwent delayed diagnosis.Two cases of extensive pelvic abscess due to missed diagnosis of vaginal laceration were treated with debridement and external fixation of pelvic fracture,and reconstructions of vagina were performed after infection control.Results Twelve patients survived,and 1 patient died 6 h after admission.Eleven patients were followed up for 8 to 36 months (average,17 months).Among 9 patients who underwent one-stage repair of vagina,5 married patients had normal sexual life,1 suffered from pain during sexual intercourse,and 3 unmarried patients had normal menses.Two patients who underwent second-stage reconstruction of vagina suffered from pain during sexual intercourse.At final follow-up,the mean Majeed score was 82.2 (range,56 to 96),and the results were excellent in 6 cases,good in 3 cases,fair in 2 cases.Conclusion Vaginal injury should be highly suspected in females with anterior pelvic ring fracture.Early diagnosis and repair of vaginal injury is crucial to good clinical outcomes.Delayed diagnosis and treatment may lead to severe complications.

Fecal diversion in the management of pelvic fractures associated with perineal injuries / 中华骨科杂志

ObjectiveTo investigate fecal diversion in the management of pelvic fractures associated with perineal injuries.MethodsThis retrospective study involved 27 patients of pelvic fractures associated with perineal injuries during April 2005 to April 2011.There were 23 males and 4 females,and the mean age was 32.9 years old (range,16-62 years old).Fractures type according to Tile classification:4 cases were type A,10 cases were type B,and 13 cases were type C.The pelvic external fixator and fecal diversion were selectively used.Results Of the 27 patients of pelvic fractures associated with perineal injuries,24survived.The overall mortality of pelvic fractures associated with perineal injuries in the present study was 11％.The survived 24 patients were totally reviewed clinically.The mean follow-up time of these patients was 10.9 months (range,4-42 months).Of those patients who underwent early fecal diversion (＜ 48 h),none experienced infectious completions.However,of those underwent non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion),four patients experienced infectious completions.Fisher's exact test was used to compare the infection rate of these two groups.And the result of Fisher's exact test demonstrated that those patients who underwent early (＜ 48 h) fecal diversion and non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion).ConclusionStabilization of hemodynamic; selective fecal diversion; early stabilization of pelvic fracture are necessary for the emergency management of pelvic fractures associated with perineal injuries.Rectal injury and severe perineal injury without involvement of rectum should undergo fecal diversion.Early fecal diversion (＜ 48 h) could reduce the infection rate of pelvic fractures associated with perineal injuries.