Fractura de pelvis inestable. Estudio de cohorte longitudinal

Abstract

BackgroundThere is no consensus about treatment for patients with an unstable pelvic fracture and even less when hemodynamic instability is associated with. Study was conducted to determine the outcome in the management of patients with an unstable fracture of the pelvis, with or without hemodynamic instability, in a trauma referral center in Medellín, Colombia. MethodsA retrospective, longitudinal cohort study was conducted including patients with pelvic fracture due to trauma. Demographic data, vital signs on admission, presence of hemodynamic shock on admission (according to the ATLS scale), method of bleeding control, transfusion requirement and overall mortality rate were collected. An analysis was performed on a subgroup of patients who presented with signs of associated severe hemodynamic shock, defined as ATLS III-IV upon admission and a requirement for blood products of more than 8IU in the first 48hours. ResultsA total of 567 patients with any type of pelvic fracture, between January 2011 and December 2018, identified in the institution's databases, of which 149 patients presented an unstable pelvic fracture pattern (FIP). 68.1% of the patients were male, with a mean age of 34 IQR; 30 years and an Injury Severity Score (ISS) of 34 IQR: 20. Hospital mortality was 13.3%. Angioembolization and external fixator placement were the most used method of bleeding control. A total of 37 patients (27%) underwent intervention to control bleeding in the first 48hours. There were 37 patients with pelvic fracture admitted in a state of severe shock or requiring more than 8U of blood products, 17 patients required intervention in the pelvis, using single or combined ways. The mortality calculated for these patients was 32%. DiscussionPatients with unstable pelvis fractures admitted to our institution have a high mortality rate and it is even higher in patients who present with severe shock. Various methods were used to control bleeding similar to those indicated in the current literature. We require a sustained institutional effort to treat pelvic fractures and reduce the mortality of our patients, and knowing our population characteristcs allows us to guide management strategies.Evidence Level: III