ABSTRACT
From January 1986 to January 1995, 99 consecutive cases with a ruptured spleen were analysed retrospectively. Diagnostic peritoneal lavage was replaced by abdominal ultrasound as a routine screening investigation in blunt abdominal trauma after 1991. An abdominal computed tomography scan carried out in stable circulatory conditions provided additional information in 80% of the cases. The choice of treatment was related to the extent of the splenic damage and associated injuries. Even in degree IV ruptures splenorrhaphy was carried out successfully in 38% (five out of 12). The Hospital Trauma Index-Injury Severity Score (HTI-ISS) was significantly lower (17.7; n = 43) in conservative treatment than in cases treated by splenorrhaphy (27.6; n = 25) or splenectomy (33.6; n = 31). Conservative treatment (n = 43) resulted in a secondary intervention in 19%, whereas primary splenorrhaphy (n = 25) failed once (4%). Clinical morbidity was 26%, with no significant differences between conservative treatment, splenorrhaphy and splenectomy. Early mortality (0-30 days post-trauma) reached 14%, and was related to extensive injuries in all cases. The mean HTI-ISS in patients with a fatal outcome was 50.5. Overall, 62% of the injured spleens were saved, with the rate of splenic preservation improving throughout the study period. A conservative policy was increasingly treatment of first choice in patients with stable circulatory parameters with major concomitant injuries.
Subject(s)
Spleen/injuries , Splenic Rupture/diagnosis , Splenic Rupture/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Injury Severity Score , Laparotomy , Male , Middle Aged , Prognosis , Retrospective Studies , Splenectomy , Tomography, X-Ray Computed , Ultrasonography , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/diagnosis , Wounds, Penetrating/therapyABSTRACT
Thirty-nine patients with unstable pelvic fractures were analysed retrospectively. The mean age of the group was 41 years (range 15-77). Of these cases 35 had sustained high energy trauma. The mean Hospital Trauma Index-Injury Severity Score of the population was 32 (16-66). Nine cases were haemodynamically unstable on admission. The type of unstable pelvic fracture was classified according to Tile. Sixteen patients had a type B fracture and 23 had a vertical instability (type C) fracture. In two patients, an open fracture was seen. Directly associated injuries were diagnosed in 11 patients, of which eight showed damage of the urogenital system, three of the rectum and three of the peripheral nerve system. In seven cases the fracture was treated non-operatively; in the remaining 32 patients the pelvic ring was stabilized operatively. Additional therapy for hypovolaemic shock due to pelvic bleeding was necessary in six cases. The overall mortality in this series was 13 per cent. Early and aggressive resuscitation and standardized treatment in well-equipped and staffed injury centres is mandatory in these severely traumatized patients to achieve optimal results and to minimize the risk of fatal outcome.
Subject(s)
Fractures, Bone/classification , Multiple Trauma/therapy , Pelvic Bones/injuries , Accidental Falls , Accidents, Occupational , Accidents, Traffic , Adolescent , Adult , Aged , Blood Transfusion , Clinical Protocols , Female , Fracture Fixation, Internal , Fractures, Bone/etiology , Fractures, Bone/surgery , Humans , Male , Middle Aged , Multiple Trauma/etiology , Multiple Trauma/surgery , Retrospective StudiesABSTRACT
Compound unstable pelvic ring fractures should be considered a major trauma, with very high morbidity and mortality rates. Two case reports illustrate the life-threatening character. Associated injuries, specific diagnostic tests as well as methods of treatment are discussed. In both cases the result was survival with a prolonged period of rehabilitation and permanent functional impairment.
