Regional injury classification and treatment of open pelvic fractures

Abstract

Objective To propose a novel regional injury classification for open pelvic fractures and characterize its application in clinical treatment. Methods The clinical data of 67 open pelvic fractures were retrospectively analyzed which had been treated from January 2001 through December 2017 at Department of Orthopedics, Affiliated Hospital to Chengdu University. They were 48 males and 19 females, from 12 to 68 years of age (average, 34 years). According to the Tile classification, 23 cases were type A, 19 Type B and 25 Type C. Their main injuries were located at pubic perineum in 29 cases, at ilioinguinal region in 20, at sacroiliac region in 7, at ilioinguinal-perineum in 5 and at sacroiliac-perineum in 6. Our novel regional injury classification was proposed according to the assessment of soft tissue injuries at the Faringer regions. The mortalities and complications were compared between types of our regional injury classification to find associations between them. Results Despite active treatment 28 patients died, giving a mortality of 41.8% (28/67). Our regional injury classification grouped the open pelvic fractures into 4 types: perineal type (type Ⅰ), ilioinguinal type (type Ⅱ), sacroiliac type (type Ⅲ) and composite type (type Ⅳ). The mortalities for the 4 types were respectively 20.7% (6/29), 45.0% (9/20), 71.4% (5/7) and 72.7% (8/11). The mortality of open pelvic fractures was positively correlated with our classification (γ=0.620, P=0.001). Type Ⅰ mainly included cystourethral injury, anorectal injury and infection, type Ⅱ and Ⅲ injury to iliac vessels and Type Ⅳ injury to iliac vessels and infection. The incidences of complications for type Ⅲ (100.0%, 7/7) and type Ⅳ (100.0%, 11/11) were significantly higher than those for type Ⅰ (82.8%, 24/29) and type Ⅱ (85.0%, 17/20) (P<0.05). Conclusions Our regional injury classification gives clear criteria. The mortality increases gradually with the 4 types. The incidence of complications for each type varies and thus leads to different therapies. Key words: Pelvis; Fractures, open; Classification; Mortality; Treatment