Introduction Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.
Methods We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.
Results Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.
Conclusions Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.
- adult orthopaedics
- trauma management
- adult surgery
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Contributors WP, RWD: data acquisition, data analysis, data interpretation, drafting and revision of the manuscript, final approval of the version published, and agreement on all aspects of the work for accuracy and integrity. JB, EE, CJR: study conception/design, manuscript revision, final approval of the version published, and agreement on all aspects of the work for accuracy and integrity. MB: study conception/design, data analysis and interpretation, drafting and revision of the manuscript, final approval of the version published, and agreement on all aspects of the work for accuracy and integrity. All listed authors contributed to either data collection, manuscript writing, editing or project supervision. There were no contributors outside of the listed authors.
Funding This study was funded by the Uniformed Services University of the Health Sciences (Cooperative Agreement (HU0001-15-2-0001) (SC2i P)).
Disclaimer The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the US Government.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Walter Reed National Military Medical Center Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data came from our caring for casualties database, for which access is classified. Any questions or concerns about the data set may be addressed by the research team, appropriately removing patient identifiers.
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