TREATMENT OUTCOMES OF OPEN PELVIC FRACTURES ASSOCIATED WITH SEVERE PERINEAL INJURIES / 现代医院

ABSTRACT

Objective The aim of this study was to evaluate the management outcomes of open pelvic fractures asso-ciated 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 2009 and September 2013. 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 Two patients (13.3%) died; the first with a type Ⅲ anteroposterior compression (APC) pelvis fracture was due to uncontrolled hemorrhagic shock, while the latter was due to septicaemia.We had one case with acute renal failure which improved with medical treatment.One patient (6.6%) had sciatic nerve palsy associated with type Ⅱ lateral compression (LC) pelvis fracture.Five hemodynami-cally unstable patients (33%) underwent explorative laparotomy for suspected intra-abdominal injuries.All of these patients had intra -abdominal fluid based on FAST examination.Three of them had large expanding pelvic hematoma and two had spleen injury.Conclusion Open pelvic fractures with extensive perineal injuries of mortality rates are high.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 .