Open pelvic fractures: the University of Tennessee Medical Center at Knoxville experience over ten years.

Introduction: Open fractures of the pelvis remain a devastating injury with a high mortality and morbidity. Such injuries require an aggressive treatment plan and the coordination of trauma and orthopaedic surgeons to achieve the best outcomes. We report our experience at the University of Tennessee Medical Center at Knoxville with open pelvic fractures over the last ten years.

Methods: After IRB and institutional approval, we reviewed patients admitted with a diagnosis of open fracture of the pelvis from 1999 to 2009. Demographic and admission data were recorded in the trauma registry (TRACS) of the Level I Trauma Center, serving the 1.2 million people living in the regions of east Tennessee, western North Carolina and southeastern Kentucky. Data on fractures were obtained from review of the medical records and radiographs within the chart.

Results: There were 3053 pelvic fractures from January 1999 to December 2009. There were 231 deaths in this group (6%) and ages ranged from 18 to 89 years old and Injury Severity Scores ranged from 4 to 75, with a mean of 18.3. Seventy five percent of patients were able to be discharged home. Fifty-two fractures were open. There were 43 men and the mean age was 39 years old. Average ISS was 23 and ranged from 5 to 50. There were 10 deaths (19%) and eight patients underwent angioembolization for control of bleeding (3 deaths). Motorcycle crashes were the most frequent cause of an open fracture, with lateral compression injuries representing 71%. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care and is presented.

Discussion: Open pelvic fractures are usually the result of a high energy transfer, and convey a high morbidity and mortality. A defined resuscitation and fixation strategy improves outcome from historical reports. Injuries from penetrating mechanisms are associated with less morbidity and lower mortality.