Pelvic ring disruptions: Effective classification system and treatment protocols

Andrew R. Burgess, Brian J. Eastridge, Jeremy W.R. Young, T. Scott Ellison, P. Stribling Ellison, Attila Poka, G. Howard Bathon, Robert J. Brumback

Research output: Contribution to journalArticle

592 Scopus citations

Abstract

From January 1, 1985, to September 10, 1988, 210 consecutive patients with high-energy pelvic ring disruptions (exclusive of acetabular fractures) were admitted to a statewide referral center for adult multiple trauma. They were treated by one of four attending orthopaedic traumatologists per protocol as determined by their injury classification and hemodynamic status; the injury classification system was based on the vector of force involved and the quantification of disruption from that force, i.e., lateral compression, anteroposterior compression, vertical shear, and combined mechanical injury. Of the 210 patients, 162 had complete charts: 126 (78.0%) were admitted directly from the scene, 110 (67.9%) were injured in motor vehicle or motorcycle accidents, 25 (15.0%) were admitted in shock (blood pressure <90 mm Hg), the average Glasgow Coma Score was 13.2, and the average Injury Severity Score was 25.8. Treatment of the pelvic fracture included the following methods (alone or in combination): acute external fixation (45.0; 28.0%), open reduction/internal fixation (22; 13.5%), acute arterial embolization (11; 7.0%), and bedrest (68; 42.0%). Overall blood replacement averaged 5.9 units (lateral compression, 3.6 units; anteroposterior compression, 14.8 units; vertical shear, 9.2 units; combined mechanical, 8.5 units). Overall mortality was 8.6% (lateral compression, 7.0%; anteroposterior, 20.0%, vertical shear, 0%; combined mechanical, 18.0%). The cause of death was associated with the pelvic fracture in less than 50%; no patient with an isolated or vertical shear pelvic injury died. We conclude that the predictive value of our classification system (incorporating appreciation of the causative forces and resulting injury patterns) and our classification-based treatment protocols reduce the morbidity and mortality related to pelvic ring disruption.

Original languageEnglish (US)
Pages (from-to)848-856
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume30
Issue number7
DOIs
StatePublished - Jul 1990

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Burgess, A. R., Eastridge, B. J., Young, J. W. R., Ellison, T. S., Ellison, P. S., Poka, A., Bathon, G. H., & Brumback, R. J. (1990). Pelvic ring disruptions: Effective classification system and treatment protocols. Journal of Trauma - Injury, Infection and Critical Care, 30(7), 848-856. https://doi.org/10.1097/00005373-199007000-00015