Outcome of Haemodynamically Unstable Open Pelvic Fracture Patients Managed with “3-in-1” Pelvic Damage Control Protocol in a Major Trauma Centre

Abstract

Introduction Open pelvic fractures are one of the most challenging and severe injuries of orthopaedics. These patients usually are associated with high mortality and morbidity. Therefore, multiple studies have suggested different methods to deal with this challenging problem. Our hospital is one of the few trauma centers in Hong Kong that deals with these patients. We have developed a “3-in-1” pelvic damage control protocol that strategically treats patients with pelvic injuries with open fractures. This article aims to review the outcomes of patients suffering from open pelvic fractures, admitted from January 2011 to 2016. Patients & Methods All patients diagnosed with hemodynamically unstable open fracture admitted from January 2011 to 2016 were retrospectively reviewed. All these patients were treated with our hospital's “3-in-1” pelvic damage control protocol. We analyzed their demographics, associated injuries, Injury Severity and final outcomes. Results Twelve consecutive patients were included in this study. Seventy-five percent (n = 9) of them were successfully resuscitated and discharged from hospital as their final outcome. Conclusion Our hospital's “3-in-1” pelvic damage control protocol improves the survival rate of patients suffering from haemodynamically unstable open fracture, including open fracture. External fixation of pelvis, retroperitoneal packing and emergency angiography with embolization play important and inseparable roles in management of these critical patients. Adequate wound lavage, timely urinary and faecal diversion will improve the overall morbidity and survival further.