Long-term outcomes in open pelvic fractures

Background: Open pelvic fractures represent one of the most devastating injuries in orthopedic trauma, The purpose of this study was to document the injury characteristics, complications, mortality, and long-term, health-related quality of life outcomes in patients with open pelvic fractures, Methods: The trauma registry at an adult trauma center was used to identify all multiple system blunt trauma patients with a pelvic fracture from January of 1987 to August of 1995 (n = 1,179), Demographic data, mechanism of injury, and fracture type were determined from hospital records, Short-term outcome measures included infectious complications, mortality, and length of stay in hospital, Long-term outcomes of survivors were obtained by telephone interview using the SF-36 Health Survey and the Functional Independence Measure, Results: Open pelvic fractures were uncommon, occurring in 44 patients (4%), Patients with open fractures were about 9 gears younger, on average, than patients with closed fractures (30 vs, 39, p < 0.001), Similarly, patients with open fractures were more likely to be male (75 vs, 57%,p < 0.02), more likely to have been involved in a motorcycle crash (27 vs. 6%, p < 0.001), and more likely to have an unstable pelvis ring disruption (45 vs, 25%,p < 0.001), Open pelvic fracture patients required more blood than closed pelvic fracture patients, both in the first day (16 vs, 4 units, p < 0.001) and during the total hospital admission (29 vs, 9 units,p < 0.001), Five patients with perineal wounds did not receive a diverting colostomy; in turn, these individuals had a total of six pelvic infectious complications (one abscess, two with osteomyelitis, and three perineal wound infections), Overall, 11 patients died, six patients were lost to follow-up, and 27 were long-term survivors (mean duration of 4 years), Chronic disability was common after a pelvic fracture, with problems related to physical role performance and physical functioning, and was particularly severe after an open pelvic fracture (p < 0.05 for both as measured bg the SF-36). Conclusions: Patients with open pelvic fractures often survive, need to be treated with massive blood transfusions, and often require a colostomy, They are frequently left with chronic pain and residual disabilities in physical functioning and physical roles, and many remain unemployed years after injury.