Clinical Implication of Pelvic Ring Disruption in Blunt Trauma

ABSTRACT

PURPOSE: Existing classifications on types of pelvic fractures in current use usually are orthopedic treatment oriented and depend on the results of late examinations, such as CT scans, in which differentiation of early diagnosis is difficult. The authors carried out this study in order to provide early assessment concerning the prognosis of emergent pelvic fracture patients to classify the type of pelvic fracture by using the Young classification method obtained through an early pelvis AP view study. METHODS: We performed a retrospective review of 89 patients with pelvic bone fractures seen at our hospital between March 2001 and February 2003. The patients were divided into two groups (simple pelvic fracture and pelvic ring disruption) according to the type of injury. We compared clinical data such as age, vital signs, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and initial hemoglobin between the two groups. We also compared associated abdominal or urogenital injuries and extra-pelvic injuries between the two groups. RESULTS: Patients with pelvic ring disruption (n=51) had lower blood pressures ( p=0.003), higher pulse rates (p=0.017), higher RTSs ( p=0.034), and higher ISSs (p=0.019) than those with a simple pelvic fracture (n=38). A comparison of associated injuries between the two groups showed that patients with a pelvic ring disruption had higher incidences of retroperitoneal hematoma (p=0.026), urogenital injury (p=0.003), and thoracic injury (p=0.019) than those with a simple pelvic fracture. CONCLUSION: The pelvic ring disruption group showed more unstable hemodynamic changes together with higher incidences of associated injuries than the simple pelvic fracture group. Therefore, early classification by means of the Young method is considered to be beneficial in the treatment of and in the assessment of the prognosis for pelvic fracture patients at an emergency center.