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*ACUTE INTERNAL FIXATION OF PELVIC RING FRACTURES: SAFE AND EFFICIENT
Author(s) -
Enninghorst N.,
Toth L.,
King K.,
Evans J.,
Balogh Z.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04934_11.x
Subject(s) - medicine , internal fixation , polytrauma , pelvic fracture , surgery , demographics , injury severity score , retrospective cohort study , angiography , poison control , pelvis , injury prevention , emergency medicine , demography , sociology
Background: High energy pelvic ring fractures often occur on polytrauma where staged surgery is recommended. The purpose of this study was to evaluate the safety and efficacy of acute pelvic ORIF which is still controversial. Methods: 45‐month retrospective review was performed. All high energy trauma patients requiring internal fixation were included. Patients were acute ORIF (<24 hrs) or late ORIF (>24 hrs). Demographics, ISS, pelvic AIS, 24 hrs pack cell transfusions, physiological parameters, time to OT, angiography requirement, LOS and mortality were recorded. Data is presented as mean ± SD or percentages. Statistical significant was at *p < 0.05. Results: Forty‐six patients met inclusion criteria, seventeen patients had acute definitive ORIF (5.5 hrs to OT) and twenty‐nine late definitive ORIF (5 days to OT). Demographics, (age: 48 ± 22 years vs. 40 ± 14, gender: 82% vs. 79% males), injury severity (ISS: 30 ± 18 vs. 24.5 ± 13, pelvic AIS: 3.7 ± 1 vs. 3.4 ± 1.1) and 24 hrs transfusion requirements (4.7 ± 5 U vs. 6.6 ± 4 U) were not statistically different between groups. Initial shock parameters were significantly worse in the acute group (*SBP 69.7 ± 17 vs. 108 ± 21, *BD −7.35 ± 4 vs. −4.9 ± 1.5, *Lactate 6.67 ± 7 vs. 2.51 ± 1.3). Angiography was used in 18% (3/17) vs. 21% (6/29) of the cases. All acute ORIF patients survived and one (3%) of the delayed ORIF patients died. The shorter hospital LOS was not significant (25 ± 24 vs. 37 ± 32 days) while the ICU LOS was similar 12/19 patients with 2.9 ± 2.5 days vs. 15/27 patients with 3.7 ± 3.6 days). Conclusion: Acute ORIF of unstable pelvic ring fractures could be performed even in severely shocked polytrauma patients. It did not lead to increased ICU LOS and could decrease the hospital LOS.